Provider First Line Business Practice Location Address:
198 FOSTER AVE STE B
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:
11230-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-845-3005
Provider Business Practice Location Address Fax Number:
718-854-9803
Provider Enumeration Date:
09/20/2006