Provider First Line Business Practice Location Address:
HEALTH REVIVAL MEDICAL PC
Provider Second Line Business Practice Location Address:
162 BRIGHTON STREET
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-5237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-891-8822
Provider Business Practice Location Address Fax Number:
718-891-8823
Provider Enumeration Date:
06/27/2006