Provider First Line Business Practice Location Address:
5369 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:
11203-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-298-2222
Provider Business Practice Location Address Fax Number:
718-298-3333
Provider Enumeration Date:
12/22/2011