Provider First Line Business Practice Location Address:
1550 OVINGTON AVE
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:
11219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-256-1570
Provider Business Practice Location Address Fax Number:
718-837-1412
Provider Enumeration Date:
09/14/2006