Provider First Line Business Practice Location Address:
1871 PROSPECT PL APT 2F
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:
11233-6445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-503-4150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2026