Provider First Line Business Practice Location Address:
4960 BROADWAY APT 1C
Provider Second Line Business Practice Location Address:
NEW YORK FAMILY PRACTICE, PLLC
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10034-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-304-0682
Provider Business Practice Location Address Fax Number:
212-569-1967
Provider Enumeration Date:
06/27/2006