Provider First Line Business Practice Location Address:
55 27TH 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:
11214-5507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-373-1828
Provider Business Practice Location Address Fax Number:
718-946-6794
Provider Enumeration Date:
11/28/2006