Provider First Line Business Practice Location Address:
390 KINGS HWY # 1
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:
11223-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-336-6073
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006