Provider First Line Business Practice Location Address:
341 DECATUR 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:
11233-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-613-1353
Provider Business Practice Location Address Fax Number:
718-613-1354
Provider Enumeration Date:
10/12/2006