Provider First Line Business Practice Location Address:
4802 10TH AVE
Provider Second Line Business Practice Location Address:
MAIMONIDES MEDICAL CENTER, DEPARTMENT OF PEDIATRIC GI
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-283-7329
Provider Business Practice Location Address Fax Number:
718-635-6149
Provider Enumeration Date:
07/10/2008