Provider First Line Business Practice Location Address:
1011 AVENUE Z
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:
11235-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-332-3838
Provider Business Practice Location Address Fax Number:
718-332-3888
Provider Enumeration Date:
06/17/2008