Provider First Line Business Practice Location Address:
38 6TH AVE
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:
11217-4187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-362-3225
Provider Business Practice Location Address Fax Number:
718-622-1369
Provider Enumeration Date:
12/09/2005