Provider First Line Business Practice Location Address:
1111 AMSTERDAM AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR PHARMACY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-523-4670
Provider Business Practice Location Address Fax Number:
212-523-5703
Provider Enumeration Date:
04/16/2010