Provider First Line Business Practice Location Address:
62 2ND PLACE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-625-7147
Provider Business Practice Location Address Fax Number:
718-855-6071
Provider Enumeration Date:
12/08/2006