Provider First Line Business Practice Location Address:
1162 EASTERN PKWY
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:
11213-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-221-1598
Provider Business Practice Location Address Fax Number:
718-221-4147
Provider Enumeration Date:
10/26/2026