Provider First Line Business Practice Location Address:
119 WASHINGTON PL APT A
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:
10014-3875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-741-7792
Provider Business Practice Location Address Fax Number:
212-741-6678
Provider Enumeration Date:
07/26/2006