Provider First Line Business Practice Location Address:
184 RIDGEWOOD 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:
11208-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-308-4966
Provider Business Practice Location Address Fax Number:
516-590-7573
Provider Enumeration Date:
04/10/2026