Provider First Line Business Practice Location Address:
88 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
APT 1LEFT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11238-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-414-4247
Provider Business Practice Location Address Fax Number:
718-989-4877
Provider Enumeration Date:
12/12/2006