Provider First Line Business Practice Location Address:
242 E 19TH ST
Provider Second Line Business Practice Location Address:
DOCTOR'S OFFICE #2
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-477-3360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007