Provider First Line Business Practice Location Address:
1323 E 15TH ST
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:
11230-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-627-5781
Provider Business Practice Location Address Fax Number:
718-679-9656
Provider Enumeration Date:
12/21/2022