Provider First Line Business Practice Location Address:
1018 CONEY ISLAND 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:
11230-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-434-4000
Provider Business Practice Location Address Fax Number:
718-421-1697
Provider Enumeration Date:
09/25/2006