Provider First Line Business Practice Location Address:
710 W 168TH ST
Provider Second Line Business Practice Location Address:
NEUROLOGICAL INSTITUTE-12TH 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:
10032-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-305-9758
Provider Business Practice Location Address Fax Number:
212-342-1699
Provider Enumeration Date:
09/25/2006