Provider First Line Business Practice Location Address:
2000 KINGS HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 1E
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-787-1525
Provider Business Practice Location Address Fax Number:
718-787-1530
Provider Enumeration Date:
01/22/2007