Provider First Line Business Practice Location Address:
2925 KINGS HWY
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:
11229-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-677-3871
Provider Business Practice Location Address Fax Number:
718-677-7598
Provider Enumeration Date:
09/24/2008