Provider First Line Business Practice Location Address:
2425 KINGS HWY
Provider Second Line Business Practice Location Address:
SUITE A9
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-338-1729
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2010