Provider First Line Business Practice Location Address:
336 HIMROD 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:
11237-4871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-899-0060
Provider Business Practice Location Address Fax Number:
718-559-6758
Provider Enumeration Date:
07/31/2025