Provider First Line Business Practice Location Address:
189 8TH AVE
Provider Second Line Business Practice Location Address:
APT 1L
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-2234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-638-9544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007