Provider First Line Business Practice Location Address:
249 KINGSLAND AVE
Provider Second Line Business Practice Location Address:
APT. 2
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11222-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-581-0147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2012