Provider First Line Business Practice Location Address:
2120 OCEAN AVE, 2ND FL
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:
11229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-645-8088
Provider Business Practice Location Address Fax Number:
718-676-7009
Provider Enumeration Date:
10/15/2010