Provider First Line Business Practice Location Address:
1050 OCEAN AVE STE A1
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:
11226-9205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-434-2992
Provider Business Practice Location Address Fax Number:
718-434-2997
Provider Enumeration Date:
09/26/2008