Provider First Line Business Practice Location Address:
462 FIRST AVENUE
Provider Second Line Business Practice Location Address:
AMBULATORY CARE BUILDING - 2D
Provider Business Practice Location Address City Name:
NEW YORK
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:
212-562-5555
Provider Business Practice Location Address Fax Number:
979-200-4049
Provider Enumeration Date:
04/04/2017