Provider First Line Business Practice Location Address:
1420 OCEAN PKWY
Provider Second Line Business Practice Location Address:
2H
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-6454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-836-3980
Provider Business Practice Location Address Fax Number:
718-998-2578
Provider Enumeration Date:
07/24/2012