Provider First Line Business Practice Location Address:
136 AVENUE U
Provider Second Line Business Practice Location Address:
ATTN: STORE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11223-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-372-2299
Provider Business Practice Location Address Fax Number:
718-372-2299
Provider Enumeration Date:
10/16/2008