Provider First Line Business Practice Location Address:
29 LOUIS PL
Provider Second Line Business Practice Location Address:
APT 2
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11233-6507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-928-7172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2008