Provider First Line Business Practice Location Address:
625 OVINGTON AVE
Provider Second Line Business Practice Location Address:
GROUND LOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-333-5140
Provider Business Practice Location Address Fax Number:
718-333-5143
Provider Enumeration Date:
12/21/2011