Provider First Line Business Practice Location Address: 
MAIMONIDES MEDICAL CENTER
    Provider Second Line Business Practice Location Address: 
4802, 10TH AVENUE
    Provider Business Practice Location Address City Name: 
BROOKLYN
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11219
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
718-283-6000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/23/2020