Provider First Line Business Practice Location Address:
2769 CONEY ISLAND AVENUE
Provider Second Line Business Practice Location Address:
3RD 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-676-6464
Provider Business Practice Location Address Fax Number:
718-676-6467
Provider Enumeration Date:
12/08/2005