Provider First Line Business Practice Location Address:
2662 OCEAN AVE
Provider Second Line Business Practice Location Address:
S.A-6
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-4557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-646-7271
Provider Business Practice Location Address Fax Number:
718-646-6664
Provider Enumeration Date:
10/18/2005