Provider First Line Business Practice Location Address:
1278 OCEAN PARKWAY, GROUND 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:
11230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-677-7484
Provider Business Practice Location Address Fax Number:
718-677-6499
Provider Enumeration Date:
05/02/2013