Provider First Line Business Practice Location Address:
20 PLAZA ST E
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:
11238-4955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-638-6387
Provider Business Practice Location Address Fax Number:
718-636-5372
Provider Enumeration Date:
12/05/2005