Provider First Line Business Practice Location Address:
2940 OCEAN PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 1-A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-265-9332
Provider Business Practice Location Address Fax Number:
718-265-8601
Provider Enumeration Date:
12/26/2006