Provider First Line Business Practice Location Address:
3131 KINGS HIGHWAY
Provider Second Line Business Practice Location Address:
LEVEL C, SUITE C6
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-951-9919
Provider Business Practice Location Address Fax Number:
718-434-0395
Provider Enumeration Date:
11/11/2015