Provider First Line Business Practice Location Address:
1893 OCEAN 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:
11230-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-258-6504
Provider Business Practice Location Address Fax Number:
718-252-3640
Provider Enumeration Date:
11/28/2006