Provider First Line Business Practice Location Address:
3130 BRIGHTON 6TH ST
Provider Second Line Business Practice Location Address:
1D
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-6954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-648-2067
Provider Business Practice Location Address Fax Number:
718-648-2167
Provider Enumeration Date:
10/20/2005