Provider First Line Business Practice Location Address:
30 ST JAMES PLACE
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:
11205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-622-6025
Provider Business Practice Location Address Fax Number:
718-399-9305
Provider Enumeration Date:
11/01/2006