Provider First Line Business Practice Location Address:
140 LAWRENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-1171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-871-3308
Provider Business Practice Location Address Fax Number:
718-851-8836
Provider Enumeration Date:
05/03/2007