Provider First Line Business Practice Location Address:
166 CLINTON 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:
11201-4618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-834-0100
Provider Business Practice Location Address Fax Number:
718-875-6602
Provider Enumeration Date:
12/29/2005