Provider First Line Business Practice Location Address:
FIRST AVE AT 16TH ST
Provider Second Line Business Practice Location Address:
BETH ISRAEL MED CTR FIERMAN HALL 9TH FL
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:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-2318
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2011