Provider First Line Business Practice Location Address:
420 CLINTON ST
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:
11231-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-855-6171
Provider Business Practice Location Address Fax Number:
718-852-9730
Provider Enumeration Date:
10/11/2006