Provider First Line Business Practice Location Address:
1000 10TH AVE
Provider Second Line Business Practice Location Address:
ROOSEVELT DIVISION
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:
212-523-4000
Provider Business Practice Location Address Fax Number:
212-256-3594
Provider Enumeration Date:
12/28/2006