Provider First Line Business Practice Location Address:
614 LOUISIANA AVE
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-942-1380
Provider Business Practice Location Address Fax Number:
718-942-1380
Provider Enumeration Date:
10/24/2006