Provider First Line Business Practice Location Address:
596 LOUISIANA AVE # 1
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:
11239-1525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-642-6449
Provider Business Practice Location Address Fax Number:
718-642-4584
Provider Enumeration Date:
05/03/2007