Provider First Line Business Practice Location Address:
111 E 210 STREET
Provider Second Line Business Practice Location Address:
MONTEFIORE MEDICAL CENTER, EPILEPSY CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-1046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-430-2447
Provider Business Practice Location Address Fax Number:
718-430-8899
Provider Enumeration Date:
06/25/2008