Provider First Line Business Practice Location Address:
2101 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:
11229-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-951-2261
Provider Business Practice Location Address Fax Number:
718-951-2018
Provider Enumeration Date:
11/26/2007