Provider First Line Business Practice Location Address:
FIRST AVENUE AND 16TH STREET
Provider Second Line Business Practice Location Address:
MILTON AND CARROLL PETRIE DIVISION
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-2000
Provider Business Practice Location Address Fax Number:
212-256-3594
Provider Enumeration Date:
12/29/2006