Provider First Line Business Practice Location Address:
3063 BRIGHTON 6TH ST
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:
11235-6409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-669-6000
Provider Business Practice Location Address Fax Number:
718-600-6675
Provider Enumeration Date:
10/26/2026