Provider First Line Business Practice Location Address:
1153 58TH ST
Provider Second Line Business Practice Location Address:
BORO PARK PRIMARY MEDICAL PLLC
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-4526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-431-9870
Provider Business Practice Location Address Fax Number:
718-484-0236
Provider Enumeration Date:
05/26/2006