Provider First Line Business Practice Location Address:
8413 13TH AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11228-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-234-0979
Provider Business Practice Location Address Fax Number:
718-234-2729
Provider Enumeration Date:
06/29/2006