Provider First Line Business Practice Location Address:
2258 3RD AVE
Provider Second Line Business Practice Location Address:
(CORNER OF E 123RD ST AND 3RD AVE)
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10035-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-289-7800
Provider Business Practice Location Address Fax Number:
212-289-7806
Provider Enumeration Date:
12/11/2012