Provider First Line Business Practice Location Address:
1211 AVENUE I
Provider Second Line Business Practice Location Address:
BROOKLYN
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-342-8189
Provider Business Practice Location Address Fax Number:
718-709-8862
Provider Enumeration Date:
04/23/2007