Provider First Line Business Practice Location Address:
140 CLINTON 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:
11201-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-624-4465
Provider Business Practice Location Address Fax Number:
718-722-7483
Provider Enumeration Date:
07/27/2006