Provider First Line Business Practice Location Address:
1113 CHURCH AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11218-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-941-7275
Provider Business Practice Location Address Fax Number:
718-532-0917
Provider Enumeration Date:
10/20/2005