Provider First Line Business Practice Location Address:
622 W 168 STREET PH 1-137
Provider Second Line Business Practice Location Address:
COLUMBIA UNIVERSITY MED 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:
10032-3784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-305-2995
Provider Business Practice Location Address Fax Number:
212-305-6792
Provider Enumeration Date:
07/12/2006