Provider First Line Business Practice Location Address: 
760 BROADWAY
    Provider Second Line Business Practice Location Address: 
WOODHULL MEDICAL & MENTAL HEALTH CENTER
    Provider Business Practice Location Address City Name: 
BROOKLYN
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11206
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
718-963-8000
    Provider Business Practice Location Address Fax Number: 
973-442-1300
    Provider Enumeration Date: 
01/04/2006