Provider First Line Business Practice Location Address:
UPPER EAST SIDE - E 84TH ST
Provider Second Line Business Practice Location Address:
245 E 84TH ST, GROUND FLOOR
Provider Business Practice Location Address City Name:
NEWYORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-841-1414
Provider Business Practice Location Address Fax Number:
212-379-2122
Provider Enumeration Date:
08/22/2023