Provider First Line Business Practice Location Address:
11 BAY 20TH STREET
Provider Second Line Business Practice Location Address:
CELLAR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-941-7190
Provider Business Practice Location Address Fax Number:
718-540-4974
Provider Enumeration Date:
02/15/2024