Provider First Line Business Practice Location Address:
2270 KIMBALL ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-253-6616
Provider Business Practice Location Address Fax Number:
718-253-7059
Provider Enumeration Date:
02/02/2006