Provider First Line Business Practice Location Address:
242 A 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:
11201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-624-6618
Provider Business Practice Location Address Fax Number:
718-246-1327
Provider Enumeration Date:
03/09/2006