Provider First Line Business Practice Location Address:
20 PLAZA ST
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:
11238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-636-1333
Provider Business Practice Location Address Fax Number:
718-833-5237
Provider Enumeration Date:
11/24/2006