Provider First Line Business Practice Location Address:
937 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:
11223-2336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-336-0783
Provider Business Practice Location Address Fax Number:
718-336-7203
Provider Enumeration Date:
04/15/2013