Provider First Line Business Practice Location Address:
2807 KINGS HWY
Provider Second Line Business Practice Location Address:
4F
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-483-4958
Provider Business Practice Location Address Fax Number:
718-247-1651
Provider Enumeration Date:
07/27/2016