Provider First Line Business Practice Location Address:
5105 KINGS PLZ
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:
11234-5218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-252-8333
Provider Business Practice Location Address Fax Number:
718-377-7847
Provider Enumeration Date:
05/08/2007