Provider First Line Business Practice Location Address:
2424 KINGS HWY STE 1E
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:
11229-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-338-9660
Provider Business Practice Location Address Fax Number:
718-338-9659
Provider Enumeration Date:
08/01/2023