Provider First Line Business Practice Location Address:
1707 KINGS HWY FL 2
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:
11229-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-348-5567
Provider Business Practice Location Address Fax Number:
718-709-9898
Provider Enumeration Date:
02/27/2023