Provider First Line Business Practice Location Address:
3319 KINGS HWY
Provider Second Line Business Practice Location Address:
SUITE 1J
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-676-4067
Provider Business Practice Location Address Fax Number:
718-676-4068
Provider Enumeration Date:
05/18/2006