Provider First Line Business Practice Location Address:
3201 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:
11234-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-6426
Provider Business Practice Location Address Fax Number:
212-876-3906
Provider Enumeration Date:
04/21/2016