Provider First Line Business Practice Location Address:
47 PLAZA ST W
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:
11217-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-207-8305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2022