Provider First Line Business Practice Location Address:
28 KINGSLAND AVE APT 1A
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:
11211-1561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-423-6820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2021