Provider First Line Business Practice Location Address:
740 NEW LOTS 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:
11207-7319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-649-0180
Provider Business Practice Location Address Fax Number:
718-649-2720
Provider Enumeration Date:
02/17/2023