Provider First Line Business Practice Location Address:
101 AVENUE OF THE AMERICAS
Provider Second Line Business Practice Location Address:
DENTAL CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-538-2818
Provider Business Practice Location Address Fax Number:
212-388-3156
Provider Enumeration Date:
11/02/2009