Provider First Line Business Practice Location Address:
1467 EAST 10TH STREET
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:
11230-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-998-1235
Provider Business Practice Location Address Fax Number:
718-375-0529
Provider Enumeration Date:
12/08/2006