Provider First Line Business Practice Location Address:
10 UNION SQUARE E
Provider Second Line Business Practice Location Address:
#2G, PHILLIPS AMBULATORY CARE CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-3801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-4521
Provider Business Practice Location Address Fax Number:
212-420-4373
Provider Enumeration Date:
12/09/2005