Provider First Line Business Practice Location Address:
1218 PROSPECT PLACE
Provider Second Line Business Practice Location Address:
CROWN HEIGHTS CHILD HEALTH CLINIC
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11213-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-735-0561
Provider Business Practice Location Address Fax Number:
718-735-6079
Provider Enumeration Date:
03/14/2006