Provider First Line Business Practice Location Address:
135 KINGSBOROUGH 1ST WALK APT 3C
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:
11233-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-808-7824
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2026