Provider First Line Business Practice Location Address:
2196 FLATBUSH 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:
11234-4326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-513-0938
Provider Business Practice Location Address Fax Number:
718-513-0939
Provider Enumeration Date:
03/30/2026