Provider First Line Business Practice Location Address:
2336 2ND AVE
Provider Second Line Business Practice Location Address:
SECOND AVENUE PHYSICIAN PRACTICE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10035-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-987-5200
Provider Business Practice Location Address Fax Number:
212-987-5210
Provider Enumeration Date:
08/09/2005