Provider First Line Business Practice Location Address:
2279 CONEY ISLAND AVENUE 2ND FLR.
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:
11223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-882-1110
Provider Business Practice Location Address Fax Number:
212-882-1120
Provider Enumeration Date:
09/13/2006