Provider First Line Business Practice Location Address:
16TH STREET AT 1ST AVENUE
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:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-477-1325
Provider Business Practice Location Address Fax Number:
212-505-6346
Provider Enumeration Date:
09/27/2006