Provider First Line Business Practice Location Address:
34 NEVINS 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:
11217-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-237-1344
Provider Business Practice Location Address Fax Number:
718-243-0081
Provider Enumeration Date:
06/11/2006