Provider First Line Business Practice Location Address: 
33 W 42ND ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
NEW YORK
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10036-8005
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
212-938-4001
    Provider Business Practice Location Address Fax Number: 
212-938-5831
    Provider Enumeration Date: 
07/05/2011