Provider First Line Business Practice Location Address:
1122 CONEY ISLAND 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:
11230-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-859-0090
Provider Business Practice Location Address Fax Number:
718-859-0048
Provider Enumeration Date:
07/28/2006