Provider First Line Business Practice Location Address:
2128 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:
11229-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-339-7469
Provider Business Practice Location Address Fax Number:
718-531-2350
Provider Enumeration Date:
08/28/2006