Provider First Line Business Practice Location Address:
800 POLY PL
Provider Second Line Business Practice Location Address:
MEDICAL SERVICE (111)
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209-7104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-526-1000
Provider Business Practice Location Address Fax Number:
718-298-8436
Provider Enumeration Date:
05/03/2006