Provider First Line Business Practice Location Address:
5412 KINGS PLAZA MALL
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:
11234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-258-0011
Provider Business Practice Location Address Fax Number:
718-258-1405
Provider Enumeration Date:
08/04/2006