Provider First Line Business Practice Location Address:
172 PEMBROKE 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:
11235-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-648-1269
Provider Business Practice Location Address Fax Number:
718-368-3271
Provider Enumeration Date:
06/21/2010