Provider First Line Business Practice Location Address:
148 BAY 49TH ST APT 2A
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:
11214-6950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-552-5882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2024