Provider First Line Business Practice Location Address:
1505 ST. MARKS AVE
Provider Second Line Business Practice Location Address:
CLINICAL OFFICE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-390-8055
Provider Business Practice Location Address Fax Number:
347-390-8020
Provider Enumeration Date:
09/08/2020