Provider First Line Business Practice Location Address:
1220 AVENUE P
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:
11229-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-336-2244
Provider Business Practice Location Address Fax Number:
718-513-6991
Provider Enumeration Date:
12/21/2006