Provider First Line Business Practice Location Address:
130 BRIGHTON BEACH 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:
11235-8002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-946-7557
Provider Business Practice Location Address Fax Number:
718-946-9680
Provider Enumeration Date:
05/16/2006