Provider First Line Business Practice Location Address:
450 CLARKSON AVE
Provider Second Line Business Practice Location Address:
SUNY DOWNSTATE MEDICAL CENTER AT LICH
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:
718-780-1881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2010