Provider First Line Business Practice Location Address:
112 PROSPECT PARK W
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:
11215-3710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-832-9488
Provider Business Practice Location Address Fax Number:
718-369-1753
Provider Enumeration Date:
08/15/2006