Provider First Line Business Practice Location Address:
1654 KIMBALL ST
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:
11234-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-377-2777
Provider Business Practice Location Address Fax Number:
718-377-2777
Provider Enumeration Date:
09/16/2006