Provider First Line Business Practice Location Address:
130 WEST 12TH STREET
Provider Second Line Business Practice Location Address:
ST.VINCENT'S HOSPITAL MANHATTAN
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-740-3602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2009