Provider First Line Business Practice Location Address:
1008 GATESAVENUE
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:
11221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-452-1307
Provider Business Practice Location Address Fax Number:
718-919-7906
Provider Enumeration Date:
04/20/2007