Provider First Line Business Practice Location Address:
2239 CHURCH AVE
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:
11226-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-941-7722
Provider Business Practice Location Address Fax Number:
718-941-0023
Provider Enumeration Date:
10/03/2006