Provider First Line Business Practice Location Address:
133 8TH AVE APT 2B
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:
11215-1786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-638-8113
Provider Business Practice Location Address Fax Number:
718-638-2903
Provider Enumeration Date:
10/31/2006