Provider First Line Business Practice Location Address:
3226 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:
11234-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-252-9100
Provider Business Practice Location Address Fax Number:
718-252-9401
Provider Enumeration Date:
03/27/2018