Provider First Line Business Practice Location Address:
468 LAFAYETTE AVE
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:
11205-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-399-6234
Provider Business Practice Location Address Fax Number:
718-399-3516
Provider Enumeration Date:
09/24/2020