Provider First Line Business Practice Location Address:
164 AVENUE U
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11223-3740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-996-8420
Provider Business Practice Location Address Fax Number:
718-714-6787
Provider Enumeration Date:
09/05/2006