Provider First Line Business Practice Location Address:
573 KINGS HIGHWAY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-627-0485
Provider Business Practice Location Address Fax Number:
718-627-2757
Provider Enumeration Date:
05/04/2007