Provider First Line Business Practice Location Address:
247 E 39TH ST
Provider Second Line Business Practice Location Address:
APT 2C
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:
212-682-8244
Provider Business Practice Location Address Fax Number:
212-213-4940
Provider Enumeration Date:
12/26/2006