Provider First Line Business Practice Location Address:
1280 EAST 12-TH STR
Provider Second Line Business Practice Location Address:
APT 3-H
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-395-0032
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2010