Provider First Line Business Practice Location Address:
152 EAST 118TH STREET
Provider Second Line Business Practice Location Address:
S1
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10035-4087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-987-6500
Provider Business Practice Location Address Fax Number:
212-987-6505
Provider Enumeration Date:
06/06/2006