Provider First Line Business Practice Location Address:
774 ROCKAWAY AVENUE
Provider Second Line Business Practice Location Address:
SUITE 101 1ST FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212-5807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-629-8995
Provider Business Practice Location Address Fax Number:
718-676-4019
Provider Enumeration Date:
10/13/2011