Provider First Line Business Practice Location Address:
1602 AVENUE U 2FL
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:
11229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-688-5273
Provider Business Practice Location Address Fax Number:
718-355-9768
Provider Enumeration Date:
08/16/2012