Provider First Line Business Practice Location Address:
3959 BROADWAY
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL NORTH - RM 215
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-1559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-342-8586
Provider Business Practice Location Address Fax Number:
212-305-5971
Provider Enumeration Date:
10/03/2006