Provider First Line Business Practice Location Address:
1707 KINGS HWY
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:
11229-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-998-0518
Provider Business Practice Location Address Fax Number:
718-998-0527
Provider Enumeration Date:
12/10/2010