Provider First Line Business Practice Location Address:
FIRST AVE. & 27TH ST.
Provider Second Line Business Practice Location Address:
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:
212-561-4132
Provider Business Practice Location Address Fax Number:
212-562-8853
Provider Enumeration Date:
01/25/2007