Provider First Line Business Practice Location Address:
192 PEMBROKE 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:
11235-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-432-8271
Provider Business Practice Location Address Fax Number:
347-252-0222
Provider Enumeration Date:
06/03/2015