Provider First Line Business Practice Location Address:
1906 KINGS HWY STE 3
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:
11229-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-713-1078
Provider Business Practice Location Address Fax Number:
929-274-2917
Provider Enumeration Date:
11/17/2016