Provider First Line Business Practice Location Address:
120 WEST 106 STREET
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-870-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2007