Provider First Line Business Practice Location Address:
2183 OCEAN AVE
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:
11229-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-382-6565
Provider Business Practice Location Address Fax Number:
718-382-6658
Provider Enumeration Date:
03/29/2007