Provider First Line Business Practice Location Address:
5379 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:
11203-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-475-1448
Provider Business Practice Location Address Fax Number:
718-475-1449
Provider Enumeration Date:
06/06/2016