Provider First Line Business Practice Location Address:
554 HENRY ST
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:
11231-2745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-625-5591
Provider Business Practice Location Address Fax Number:
718-625-1610
Provider Enumeration Date:
12/15/2006