Provider First Line Business Practice Location Address:
2212 PLUMB 1ST ST APT 3A
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:
11229-5763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-216-2397
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2007