Provider First Line Business Practice Location Address:
2818 OCEAN AVE STE 1
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:
11235-3170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-934-8484
Provider Business Practice Location Address Fax Number:
718-934-4267
Provider Enumeration Date:
12/15/2006