Provider First Line Business Practice Location Address:
1642 BATH AVE
Provider Second Line Business Practice Location Address:
STOREFRONT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11214-4584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-236-8828
Provider Business Practice Location Address Fax Number:
718-236-8829
Provider Enumeration Date:
11/19/2008