Provider First Line Business Practice Location Address:
451 CLARKSON AVENUE
Provider Second Line Business Practice Location Address:
KINGS COUNTY HOSPITAL 6TH FLOOR
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:
718-380-0338
Provider Business Practice Location Address Fax Number:
718-969-2397
Provider Enumeration Date:
04/18/2006