Provider First Line Business Practice Location Address:
395 AVENUE X
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:
11223-6004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-339-3131
Provider Business Practice Location Address Fax Number:
718-339-9232
Provider Enumeration Date:
10/07/2005