Provider First Line Business Practice Location Address:
70 LEE AVE STORE
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:
11211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-387-0185
Provider Business Practice Location Address Fax Number:
718-782-0383
Provider Enumeration Date:
02/25/2020