Provider First Line Business Practice Location Address:
220 RIVERSIDE BLVD
Provider Second Line Business Practice Location Address:
DENTAL OFFICE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10069-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-580-1140
Provider Business Practice Location Address Fax Number:
212-954-5583
Provider Enumeration Date:
09/09/2009