Provider First Line Business Practice Location Address:
80 VANDAM ST
Provider Second Line Business Practice Location Address:
C/O NURSE OFFICE, 7 TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-366-8387
Provider Business Practice Location Address Fax Number:
212-366-8319
Provider Enumeration Date:
01/11/2011