Provider First Line Business Practice Location Address:
222 W 116TH ST
Provider Second Line Business Practice Location Address:
J'VALLD CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10026-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-862-6000
Provider Business Practice Location Address Fax Number:
212-222-7955
Provider Enumeration Date:
08/31/2006