Provider First Line Business Practice Location Address:
ST LUKES ROOSEVELT HOSPITAL STOREFRONT
Provider Second Line Business Practice Location Address:
350 A W 49TH ST
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-929-2894
Provider Business Practice Location Address Fax Number:
212-496-2042
Provider Enumeration Date:
01/22/2007