Provider First Line Business Practice Location Address:
2619A ATLANTIC AVE
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:
11207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-485-7760
Provider Business Practice Location Address Fax Number:
718-485-7780
Provider Enumeration Date:
12/08/2005