Provider First Line Business Practice Location Address:
24 PAERDEGAT 12TH 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:
11236-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-371-9190
Provider Business Practice Location Address Fax Number:
718-630-3138
Provider Enumeration Date:
06/08/2007