Provider First Line Business Practice Location Address:
825 57TH ST
Provider Second Line Business Practice Location Address:
LONGEVOUS MEDICAL HEALTHCARE, PC
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-750-2090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016