Provider First Line Business Practice Location Address:
5 W 19TH ST
Provider Second Line Business Practice Location Address:
9TH FLOOR, C/O LOWER FIFTH PSYCHIATRIC
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10011-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-572-8324
Provider Business Practice Location Address Fax Number:
212-423-0584
Provider Enumeration Date:
01/26/2007