Provider First Line Business Practice Location Address: 
525 E 68TH STREET, BOX 141, DEPARTMENT OF RADIOLOGY
    Provider Second Line Business Practice Location Address: 
NEWYORK-PRESBYTERIAN - WEILL CORNELL MEDICAL COLLEGE
    Provider Business Practice Location Address City Name: 
NEW YORK
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10065-4885
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
212-746-6000
    Provider Business Practice Location Address Fax Number: 
646-962-0122
    Provider Enumeration Date: 
02/23/2015