Provider First Line Business Practice Location Address:
1312 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:
11229-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-627-0800
Provider Business Practice Location Address Fax Number:
718-627-5400
Provider Enumeration Date:
01/19/2009