Provider First Line Business Practice Location Address:
1127 LIBERTY 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:
11208-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-412-0404
Provider Business Practice Location Address Fax Number:
718-691-6915
Provider Enumeration Date:
10/21/2026