Provider First Line Business Practice Location Address:
2218 KIMBALL ST
Provider Second Line Business Practice Location Address:
SUITE M5
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-253-1087
Provider Business Practice Location Address Fax Number:
718-253-7774
Provider Enumeration Date:
05/12/2008