Provider First Line Business Practice Location Address:
161 KINGS HWY APT 2
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11223-1039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-333-9686
Provider Business Practice Location Address Fax Number:
929-333-9684
Provider Enumeration Date:
11/21/2013