Provider First Line Business Practice Location Address:
1194 SCHENECTADY 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:
11203-5828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-270-5243
Provider Business Practice Location Address Fax Number:
917-270-5243
Provider Enumeration Date:
01/27/2026