Provider First Line Business Practice Location Address:
136 SAINT JAMES PL
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:
11238-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-783-4348
Provider Business Practice Location Address Fax Number:
781-783-4593
Provider Enumeration Date:
01/23/2007