Provider First Line Business Practice Location Address:
1012 OCEAN AVE
Provider Second Line Business Practice Location Address:
1B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11226-7475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-434-9313
Provider Business Practice Location Address Fax Number:
718-421-9039
Provider Enumeration Date:
02/27/2007