Provider First Line Business Practice Location Address: 
41 EAST POST ROAD
    Provider Second Line Business Practice Location Address: 
WHITE PLAINS HOSPITAL
    Provider Business Practice Location Address City Name: 
WHITE PLAINS
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10601
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
914-681-2560
    Provider Business Practice Location Address Fax Number: 
914-681-2590
    Provider Enumeration Date: 
05/23/2007