Provider First Line Business Practice Location Address:
1707 KINGS HWY
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:
718-975-7680
Provider Business Practice Location Address Fax Number:
718-975-7681
Provider Enumeration Date:
03/08/2016