Provider First Line Business Practice Location Address:
FIFTH AVENUE & 100 ST
Provider Second Line Business Practice Location Address:
MOUNT SINAI MEDICAL CENTER
Provider Business Practice Location Address City Name:
NYC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-4844
Provider Business Practice Location Address Fax Number:
212-241-9353
Provider Enumeration Date:
05/19/2008