Provider First Line Business Practice Location Address:
142 JORALEMON ST
Provider Second Line Business Practice Location Address:
STE 9B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-858-1732
Provider Business Practice Location Address Fax Number:
718-596-3332
Provider Enumeration Date:
05/16/2007