Provider First Line Business Practice Location Address:
1075 50TH STREET
Provider Second Line Business Practice Location Address:
BROOKLYN,NEW YORK APT. R
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-986-4040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2006