Provider First Line Business Practice Location Address:
327 BEACH 19TH STREET
Provider Second Line Business Practice Location Address:
ST. JOHN'S EPISCOPAL 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:
11691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-869-7888
Provider Business Practice Location Address Fax Number:
718-869-7089
Provider Enumeration Date:
06/04/2010