Provider First Line Business Practice Location Address:
2195 THIRD AVENUE
Provider Second Line Business Practice Location Address:
THIRD HORIZON CLINIC
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-348-9095
Provider Business Practice Location Address Fax Number:
212-876-1559
Provider Enumeration Date:
07/19/2006