Provider First Line Business Practice Location Address:
142 JORALEMON STREET
Provider Second Line Business Practice Location Address:
10B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-875-1744
Provider Business Practice Location Address Fax Number:
718-875-1744
Provider Enumeration Date:
01/30/2006