Provider First Line Business Practice Location Address:
1311-1327 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
1I
Provider Business Practice Location Address City Name:
NY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-369-5837
Provider Business Practice Location Address Fax Number:
212-876-8812
Provider Enumeration Date:
05/31/2007