Provider First Line Business Practice Location Address:
760 BROADWAY DEPARTMENT OF MANAGED CARE ROOM 2B230
Provider Second Line Business Practice Location Address:
WOODHULL MENTAL & MEDICAL HEALTH CENTER
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-963-8310
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2011