Provider First Line Business Practice Location Address:
217 OVINGTON 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:
11209-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-238-0098
Provider Business Practice Location Address Fax Number:
718-836-6849
Provider Enumeration Date:
08/13/2006