Provider First Line Business Practice Location Address:
635 MADISON AVENUE
Provider Second Line Business Practice Location Address:
5TH FLOOR INTEGRATIVE CARE CENTER
Provider Business Practice Location Address City Name:
NY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-224-7927
Provider Business Practice Location Address Fax Number:
212-224-7956
Provider Enumeration Date:
05/21/2008