Provider First Line Business Practice Location Address:
ONE PENN PLAZA, 8TH FLOOR
Provider Second Line Business Practice Location Address:
OPTUM
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10119-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-799-0210
Provider Business Practice Location Address Fax Number:
516-799-0247
Provider Enumeration Date:
11/17/2013