Provider First Line Business Practice Location Address:
451 CLARKSON AVE
Provider Second Line Business Practice Location Address:
KINGS COUNTY HOSPITAL CENTER
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-2097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-245-3675
Provider Business Practice Location Address Fax Number:
718-245-4197
Provider Enumeration Date:
04/04/2007