Provider First Line Business Practice Location Address:
562 FIRST AVENUE, NEW BUILIDING, ROOM 2097
Provider Second Line Business Practice Location Address:
BELLEVUE HOSPITAL
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:
212-562-1613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006