Provider First Line Business Practice Location Address:
25 WEST 125TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N.Y.C.
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-860-0130
Provider Business Practice Location Address Fax Number:
212-274-8770
Provider Enumeration Date:
03/27/2006