Provider First Line Business Practice Location Address:
2965 OCEAN PKWY
Provider Second Line Business Practice Location Address:
BSMNT FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-8014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-332-0095
Provider Business Practice Location Address Fax Number:
718-332-4834
Provider Enumeration Date:
04/14/2008