Provider First Line Business Practice Location Address:
1724-1726 OCEAN AVE
Provider Second Line Business Practice Location Address:
BSMT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-258-2200
Provider Business Practice Location Address Fax Number:
718-258-2756
Provider Enumeration Date:
06/14/2006