Provider First Line Business Practice Location Address:
457 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:
11223-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-382-5005
Provider Business Practice Location Address Fax Number:
718-382-6963
Provider Enumeration Date:
04/11/2007