Provider First Line Business Practice Location Address:
1203 AVENUE J
Provider Second Line Business Practice Location Address:
SUITE 4A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-3669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-513-3520
Provider Business Practice Location Address Fax Number:
718-252-5070
Provider Enumeration Date:
01/31/2007