Provider First Line Business Practice Location Address:
CUMC 622 W168TH STREET VC 10 AREA D
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:
10032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-305-6428
Provider Business Practice Location Address Fax Number:
212-305-3264
Provider Enumeration Date:
06/27/2005