Provider First Line Business Practice Location Address:
1245 E 9TH ST
Provider Second Line Business Practice Location Address:
APT 1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-5152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-506-9089
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2015