Provider First Line Business Practice Location Address:
1600 AVENUE L
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:
11230-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-258-9283
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2012