Provider First Line Business Practice Location Address:
139 KANE ST
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11231-5229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-304-4701
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2008