Provider First Line Business Practice Location Address:
2301 KINGS HWY
Provider Second Line Business Practice Location Address:
APT 2P
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-677-7256
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2010