Provider First Line Business Practice Location Address: 
550 1ST AVE RM TH380
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF HEMATOPATHOLOGY
    Provider Business Practice Location Address City Name: 
NEW YORK
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10016-6402
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
212-263-5967
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/01/2011