Provider First Line Business Practice Location Address:
2516 OCEAN 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:
11229-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-769-0444
Provider Business Practice Location Address Fax Number:
718-769-5593
Provider Enumeration Date:
08/16/2005