Provider First Line Business Practice Location Address:
5735 KINGS HWY APT 1A
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:
11203-4827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-495-1961
Provider Business Practice Location Address Fax Number:
718-701-8325
Provider Enumeration Date:
12/14/2022