Provider First Line Business Practice Location Address:
BOX 1203 BROOKLYN
Provider Second Line Business Practice Location Address:
DOWNSTATE MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW YORK
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:
917-991-7807
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2015