Provider First Line Business Practice Location Address:
9920-4TH AVENUE
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:
11209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-238-1445
Provider Business Practice Location Address Fax Number:
718-238-0856
Provider Enumeration Date:
05/17/2007