Provider First Line Business Practice Location Address:
149 MARINE AVE
Provider Second Line Business Practice Location Address:
SUITE LA
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209-7743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-833-8844
Provider Business Practice Location Address Fax Number:
718-238-1372
Provider Enumeration Date:
02/14/2008