Provider First Line Business Practice Location Address:
332 9TH ST
Provider Second Line Business Practice Location Address:
2ND FLOOR, APT. 1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-4058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-832-1222
Provider Business Practice Location Address Fax Number:
718-832-0796
Provider Enumeration Date:
11/19/2005