Provider First Line Business Practice Location Address:
1119 OCEAN PARKWAY
Provider Second Line Business Practice Location Address:
APT 2C
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-771-8232
Provider Business Practice Location Address Fax Number:
718-532-0395
Provider Enumeration Date:
08/20/2010