Provider First Line Business Practice Location Address:
130 KENSINGTON ST
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:
11235-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-687-8669
Provider Business Practice Location Address Fax Number:
718-332-1993
Provider Enumeration Date:
03/14/2008