Provider First Line Business Practice Location Address:
540 EAST 74TH STREET
Provider Second Line Business Practice Location Address:
DERMATOLOGY DIVISION
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-618-2313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2008