Provider First Line Business Practice Location Address:
1929 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:
11229-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-998-9595
Provider Business Practice Location Address Fax Number:
718-998-0566
Provider Enumeration Date:
03/19/2024