Provider First Line Business Practice Location Address:
5 MIDDLETON ST.. APT 5 -RR
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:
11206-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-254-0017
Provider Business Practice Location Address Fax Number:
718-388-4161
Provider Enumeration Date:
10/22/2012