Provider First Line Business Practice Location Address:
1847 PROSPECT PLACE
Provider Second Line Business Practice Location Address:
BASEMENT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-423-4632
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2018