Provider First Line Business Practice Location Address:
94 E 1ST ST
Provider Second Line Business Practice Location Address:
IH
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-677-2157
Provider Business Practice Location Address Fax Number:
212-982-2792
Provider Enumeration Date:
12/28/2005