Provider First Line Business Practice Location Address:
2148 OCEAN AVE
Provider Second Line Business Practice Location Address:
6A
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:
718-368-0600
Provider Business Practice Location Address Fax Number:
718-368-3574
Provider Enumeration Date:
01/25/2017