Provider First Line Business Practice Location Address:
2229 KNAPP ST APT 4B
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:
11229-5715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-578-6899
Provider Business Practice Location Address Fax Number:
718-873-9668
Provider Enumeration Date:
02/13/2008