Provider First Line Business Practice Location Address:
451 CLARKSON AV
Provider Second Line Business Practice Location Address:
KINGS COUNTY HOSPITAL CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-245-5209
Provider Business Practice Location Address Fax Number:
718-245-5633
Provider Enumeration Date:
07/26/2006