Provider First Line Business Practice Location Address:
2021 AVE X
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:
11235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-332-0545
Provider Business Practice Location Address Fax Number:
718-332-4209
Provider Enumeration Date:
12/06/2005