Provider First Line Business Practice Location Address:
1407 W 6TH 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:
11204-4802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-256-1057
Provider Business Practice Location Address Fax Number:
718-256-4912
Provider Enumeration Date:
12/06/2007