Provider First Line Business Practice Location Address:
1641 OCEAN AVE
Provider Second Line Business Practice Location Address:
APT.B-19
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-5046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-688-5565
Provider Business Practice Location Address Fax Number:
718-688-5565
Provider Enumeration Date:
10/02/2013