Provider First Line Business Practice Location Address:
1ST AVE AT 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-4145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2005