Provider First Line Business Practice Location Address:
142 JORALEMON ST
Provider Second Line Business Practice Location Address:
SUITE 6A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-858-6734
Provider Business Practice Location Address Fax Number:
718-875-8162
Provider Enumeration Date:
12/26/2006