Provider First Line Business Practice Location Address:
481 ATLANTIC AVE
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:
11217-1889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-237-1596
Provider Business Practice Location Address Fax Number:
718-222-1650
Provider Enumeration Date:
02/19/2006