Provider First Line Business Practice Location Address:
295 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:
11223-1348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-382-4400
Provider Business Practice Location Address Fax Number:
718-998-1764
Provider Enumeration Date:
12/28/2006