Provider First Line Business Practice Location Address:
411 W 114TH ST # 3B
Provider Second Line Business Practice Location Address:
ST. LUKE'S-ROOSEVELT HOSPITAL CENTER, WHP
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-523-2990
Provider Business Practice Location Address Fax Number:
212-523-2140
Provider Enumeration Date:
12/13/2006