Provider First Line Business Practice Location Address:
112 MINNA 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:
11218-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-812-3182
Provider Business Practice Location Address Fax Number:
718-686-1868
Provider Enumeration Date:
06/30/2012