Provider First Line Business Practice Location Address:
2467 OCEAN AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-3969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-676-1768
Provider Business Practice Location Address Fax Number:
718-676-1770
Provider Enumeration Date:
12/13/2005