Provider First Line Business Practice Location Address:
550 1ST AVE
Provider Second Line Business Practice Location Address:
BELLEVUE HOSPITAL, 8 SOUTH 4-11
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-562-3173
Provider Business Practice Location Address Fax Number:
212-562-5518
Provider Enumeration Date:
12/13/2006