Provider First Line Business Practice Location Address:
250 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:
11223-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-946-6899
Provider Business Practice Location Address Fax Number:
718-946-2743
Provider Enumeration Date:
12/26/2006