Provider First Line Business Practice Location Address:
161 FORT WASHINGTON AVENUE, SUITE 532
Provider Second Line Business Practice Location Address:
HERBERT IRVING PAVILION
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-342-3255
Provider Business Practice Location Address Fax Number:
212-342-3252
Provider Enumeration Date:
04/12/2006