Provider First Line Business Practice Location Address:
2560 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:
11229-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-646-7878
Provider Business Practice Location Address Fax Number:
718-646-4259
Provider Enumeration Date:
12/06/2005