Provider First Line Business Practice Location Address:
240 POWERS ST
Provider Second Line Business Practice Location Address:
3R
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11211-5056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-941-9215
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2013