Provider First Line Business Practice Location Address:
3215 AVENUE H BROOKLYN, NY 11210
Provider Second Line Business Practice Location Address:
SUITE 1P
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-717-2278
Provider Business Practice Location Address Fax Number:
929-234-6504
Provider Enumeration Date:
12/14/2021