Provider First Line Business Practice Location Address:
2792 OCEAN AVE
Provider Second Line Business Practice Location Address:
UNIT 5
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-4729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-975-0640
Provider Business Practice Location Address Fax Number:
718-975-0639
Provider Enumeration Date:
03/08/2012