Provider First Line Business Practice Location Address:
142 JORALEMON ST
Provider Second Line Business Practice Location Address:
SUITE 12C
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:
718-625-2116
Provider Business Practice Location Address Fax Number:
718-624-1582
Provider Enumeration Date:
04/09/2007