Provider First Line Business Practice Location Address:
1536 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:
11210-2427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-434-2222
Provider Business Practice Location Address Fax Number:
718-576-6931
Provider Enumeration Date:
12/04/2025