Provider First Line Business Practice Location Address:
148 AVENUE T, 1ST AND 2ND FLOOR
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:
11223-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
332-910-8880
Provider Business Practice Location Address Fax Number:
718-676-1858
Provider Enumeration Date:
10/01/2021