Provider First Line Business Practice Location Address:
230 KINGSTON AVE
Provider Second Line Business Practice Location Address:
APT 3S
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11213-2557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-202-4423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2009