Provider First Line Business Practice Location Address:
1641 OCEAN AVE
Provider Second Line Business Practice Location Address:
B-3
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-5046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-377-7074
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2012