Provider First Line Business Practice Location Address:
2279 CONEY ISLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-998-9890
Provider Business Practice Location Address Fax Number:
718-998-9891
Provider Enumeration Date:
04/25/2012