Provider First Line Business Practice Location Address:
1224 E 83RD ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR APT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11236-4933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-683-8506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2008