Provider First Line Business Practice Location Address:
1ST AVE AND 27TH ST
Provider Second Line Business Practice Location Address:
ROOM A560-A570 BELLEVUE HOSPITAL 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:
212-263-3005
Provider Business Practice Location Address Fax Number:
212-562-3486
Provider Enumeration Date:
04/19/2007