Provider First Line Business Practice Location Address:
1911 AVENUE L BSMT
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:
11230-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-438-8188
Provider Business Practice Location Address Fax Number:
718-853-0169
Provider Enumeration Date:
08/10/2010