Provider First Line Business Practice Location Address:
462 FIRST AVENUE
Provider Second Line Business Practice Location Address:
NB20N11 BELLEVUE HOSPITAL
Provider Business Practice Location Address City Name:
NY
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:
212-562-4299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007