Provider First Line Business Practice Location Address:
118 BRANTON 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:
11236-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-451-2623
Provider Business Practice Location Address Fax Number:
718-261-2768
Provider Enumeration Date:
09/21/2007