Provider First Line Business Practice Location Address:
1425 KINGS HWY STE 4
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:
11229-2087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-627-0300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2012