Provider First Line Business Practice Location Address:
2219 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-569-0696
Provider Business Practice Location Address Fax Number:
516-569-3677
Provider Enumeration Date:
08/15/2006