Provider First Line Business Practice Location Address:
618 AVENUE H STE C1
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:
11230-2294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-253-9110
Provider Business Practice Location Address Fax Number:
718-253-0767
Provider Enumeration Date:
07/30/2006