Provider First Line Business Practice Location Address:
121 DEKALB AVE
Provider Second Line Business Practice Location Address:
HOUSE STAFF ADMINISTRATION
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-5493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-182-5080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2023