Provider First Line Business Practice Location Address:
623 BRIGHTON BEACH AVE
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-6424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-891-0821
Provider Business Practice Location Address Fax Number:
718-891-0867
Provider Enumeration Date:
05/29/2007