Provider First Line Business Practice Location Address:
355 BARD AVENUE VILLA BUILDING 1ST FLOOR
Provider Second Line Business Practice Location Address:
DEPT. OF SURGERY, RICHMOND UNIVERSITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-818-1234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2010