Provider First Line Business Practice Location Address:
4571 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:
11234-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-692-4791
Provider Business Practice Location Address Fax Number:
718-692-3362
Provider Enumeration Date:
11/18/2005