Provider First Line Business Practice Location Address:
189 WARREN STREET
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-6459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-966-4104
Provider Business Practice Location Address Fax Number:
418-478-1285
Provider Enumeration Date:
04/26/2011