Provider First Line Business Practice Location Address:
462 FIRST AVE, ROOM A646
Provider Second Line Business Practice Location Address:
C/O LESLIE SHIMONO, PSYCH ADMIN, BELLEVUE HOSPITAL
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-286-5011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2007