Provider First Line Business Practice Location Address:
462 1ST AVENUE
Provider Second Line Business Practice Location Address:
NEW BELLEVUE HOSPITAL 7N24
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-6479
Provider Business Practice Location Address Fax Number:
212-263-8442
Provider Enumeration Date:
05/11/2007