Provider First Line Business Practice Location Address:
105 ORIENTAL BLVD STE 1
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:
11235-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-646-7174
Provider Business Practice Location Address Fax Number:
718-332-0327
Provider Enumeration Date:
06/24/2006