Provider First Line Business Practice Location Address:
1184 BRIGHTON BEACH AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-5802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-833-8777
Provider Business Practice Location Address Fax Number:
718-646-8400
Provider Enumeration Date:
07/21/2006