Provider First Line Business Practice Location Address:
1219 AMSTERDAM AVE
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:
10027-7007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-749-8480
Provider Business Practice Location Address Fax Number:
212-316-6592
Provider Enumeration Date:
01/29/2007