Provider First Line Business Practice Location Address:
MLK 13-106 506 LENOX AVENUE DEPT OF MEDICINE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-939-1406
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2023