Provider First Line Business Practice Location Address:
41-51 E 11TH STREET
Provider Second Line Business Practice Location Address:
DEPT OF COMMUNITY MEDICINE 9TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-604-8027
Provider Business Practice Location Address Fax Number:
212-604-7627
Provider Enumeration Date:
09/11/2006