Provider First Line Business Practice Location Address:
2749 CONEY ISLAND AVE
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:
11235-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-374-3316
Provider Business Practice Location Address Fax Number:
347-374-3317
Provider Enumeration Date:
09/16/2026