Provider First Line Business Practice Location Address:
2589 CONEY ISLAND 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:
11223-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-368-3698
Provider Business Practice Location Address Fax Number:
718-368-3480
Provider Enumeration Date:
02/22/2006