Provider First Line Business Practice Location Address:
130 BRIGHTON BEACH AVE STE 3
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:
11235-8067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-946-7557
Provider Business Practice Location Address Fax Number:
718-815-8122
Provider Enumeration Date:
04/15/2015