Provider First Line Business Practice Location Address:
479 LENOX RD
Provider Second Line Business Practice Location Address:
BASEMENT FRONT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-283-8634
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2009