Provider First Line Business Practice Location Address:
2020 KINGS HWY
Provider Second Line Business Practice Location Address:
1E
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-375-2020
Provider Business Practice Location Address Fax Number:
718-375-1925
Provider Enumeration Date:
08/09/2005