Provider First Line Business Practice Location Address:
2752 OCEAN AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-769-9001
Provider Business Practice Location Address Fax Number:
718-796-9002
Provider Enumeration Date:
05/12/2010