Provider First Line Business Practice Location Address:
530 FIRST AVE SUITE 3A
Provider Second Line Business Practice Location Address:
NYU MEDICAL 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:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-7378
Provider Business Practice Location Address Fax Number:
212-263-7112
Provider Enumeration Date:
11/01/2006