Provider First Line Business Practice Location Address:
557 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
8A-S
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11217-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-797-2755
Provider Business Practice Location Address Fax Number:
718-797-1025
Provider Enumeration Date:
09/28/2009