Provider First Line Business Practice Location Address:
2844 OCEAN PKWY
Provider Second Line Business Practice Location Address:
WARBASSE HOUSES
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-714-5925
Provider Business Practice Location Address Fax Number:
718-714-5936
Provider Enumeration Date:
09/20/2006