Provider First Line Business Practice Location Address:
2072 20TH LANE
Provider Second Line Business Practice Location Address:
APT 3C
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11214-6369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-374-2142
Provider Business Practice Location Address Fax Number:
718-815-8122
Provider Enumeration Date:
05/22/2008