Provider First Line Business Practice Location Address:
169 KENT 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:
11222-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-947-0709
Provider Business Practice Location Address Fax Number:
718-349-7783
Provider Enumeration Date:
06/22/2006