Provider First Line Business Practice Location Address:
2912 AVENUE X
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:
11235-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-615-0162
Provider Business Practice Location Address Fax Number:
718-934-1324
Provider Enumeration Date:
06/08/2007