Provider First Line Business Practice Location Address:
1101 BRIGHTON BEACH 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:
11235-5558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-891-2801
Provider Business Practice Location Address Fax Number:
718-743-5804
Provider Enumeration Date:
10/19/2005