Provider First Line Business Practice Location Address:
143 S 8TH ST
Provider Second Line Business Practice Location Address:
4A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11211-6167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-387-3986
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2007