Provider First Line Business Practice Location Address:
90 8TH AVE
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:
11215-1553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-622-8255
Provider Business Practice Location Address Fax Number:
718-622-6996
Provider Enumeration Date:
12/19/2006