Provider First Line Business Practice Location Address:
142 JORALEMON ST
Provider Second Line Business Practice Location Address:
SUITE 11B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-4747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-802-1565
Provider Business Practice Location Address Fax Number:
718-624-7837
Provider Enumeration Date:
01/11/2007