Provider First Line Business Practice Location Address:
117 CHURCH 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:
11218-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-854-8783
Provider Business Practice Location Address Fax Number:
718-851-3815
Provider Enumeration Date:
05/03/2011