Provider First Line Business Practice Location Address:
4812 9TH AVE
Provider Second Line Business Practice Location Address:
IS 220 RM 115
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-853-3028
Provider Business Practice Location Address Fax Number:
718-633-0133
Provider Enumeration Date:
02/16/2007