Provider First Line Business Practice Location Address:
16TH STREET 1ST AVENUE
Provider Second Line Business Practice Location Address:
BETH ISRAEL MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW YORK CITY
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:
212-420-2840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2009