Provider First Line Business Practice Location Address:
183 BUFFALO 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:
11213-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-953-9083
Provider Business Practice Location Address Fax Number:
718-953-9087
Provider Enumeration Date:
06/25/2009