Provider First Line Business Practice Location Address:
1608 AVENUE O
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-375-3572
Provider Business Practice Location Address Fax Number:
718-375-3572
Provider Enumeration Date:
01/05/2007