Provider First Line Business Practice Location Address:
641 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
7TH FLOOR, DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-888-0005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2013