Provider First Line Business Practice Location Address:
530 FIRST AVE
Provider Second Line Business Practice Location Address:
SUITE 9Q NYU MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-7552
Provider Business Practice Location Address Fax Number:
212-995-4920
Provider Enumeration Date:
10/12/2006