Provider First Line Business Practice Location Address:
1230 NEPTUNE AVE-CONEY ISLAND CTR
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:
11224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-615-3200
Provider Business Practice Location Address Fax Number:
718-615-3340
Provider Enumeration Date:
07/18/2006