Provider First Line Business Practice Location Address:
ICD 340 EAST 20TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-585-6283
Provider Business Practice Location Address Fax Number:
212-585-6209
Provider Enumeration Date:
02/14/2006