Provider First Line Business Practice Location Address:
2270 KIMBALL ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-253-0888
Provider Business Practice Location Address Fax Number:
718-228-2887
Provider Enumeration Date:
08/10/2010