Provider First Line Business Practice Location Address:
800 POLY PL RM 13-105
Provider Second Line Business Practice Location Address:
PULMONARY SECTION
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209-7104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-630-3722
Provider Business Practice Location Address Fax Number:
718-630-2889
Provider Enumeration Date:
05/01/2006