Provider First Line Business Practice Location Address:
196 BUFFALO AVE
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11213-3283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-709-3388
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2016