Provider First Line Business Practice Location Address:
7001 AVENUE U
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:
11234-6121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-241-1488
Provider Business Practice Location Address Fax Number:
718-241-0590
Provider Enumeration Date:
01/06/2010