Provider First Line Business Practice Location Address:
FIRST AVENUE AT 16 ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-2878
Provider Business Practice Location Address Fax Number:
212-420-4222
Provider Enumeration Date:
10/26/2006