Provider First Line Business Practice Location Address:
60 PLAZA ST E
Provider Second Line Business Practice Location Address:
APT.2B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11238-5040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-636-2122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2009