Provider First Line Business Practice Location Address:
3601 KINGS HWY
Provider Second Line Business Practice Location Address:
E1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-2747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-675-8754
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2012