Provider First Line Business Practice Location Address:
385 E 16TH ST
Provider Second Line Business Practice Location Address:
APT 2A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11226-5667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-282-6146
Provider Business Practice Location Address Fax Number:
718-282-6146
Provider Enumeration Date:
04/16/2007