Provider First Line Business Practice Location Address: 
650 FULTON ST
    Provider Second Line Business Practice Location Address: 
BROOKLYN PLAZA MEDICAL CENTER
    Provider Business Practice Location Address City Name: 
BROOKLYN
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11217
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
718-596-9800
    Provider Business Practice Location Address Fax Number: 
718-596-9889
    Provider Enumeration Date: 
03/02/2006