Provider First Line Business Practice Location Address: 
55 PALMER AVE
    Provider Second Line Business Practice Location Address: 
NEW YORK-PRESBYTERIAN/LAWRENCE HOSPITAL
    Provider Business Practice Location Address City Name: 
BRONXVILLE
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10708-3403
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
585-764-4099
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/15/2008