Provider First Line Business Practice Location Address: 
520 E 70TH ST # STARR-4
    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: 
10021-9800
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
212-746-2150
    Provider Business Practice Location Address Fax Number: 
212-746-6665
    Provider Enumeration Date: 
10/09/2006