Provider First Line Business Practice Location Address:
451 CLARKSON AVENUE 'T' BUILDING ROOM 473-A ,
Provider Second Line Business Practice Location Address:
KING COUNTY HOSPITAL CENTER- PROFESSIONAL AFFAIRES
Provider Business Practice Location Address City Name:
BROOKLYN
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:
718-245-3909
Provider Business Practice Location Address Fax Number:
718-245-4062
Provider Enumeration Date:
02/04/2009