Provider First Line Business Practice Location Address:
1302 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:
11229-1960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-743-7090
Provider Business Practice Location Address Fax Number:
718-743-7337
Provider Enumeration Date:
02/16/2007