Provider First Line Business Practice Location Address:
90 CHURCH ST
Provider Second Line Business Practice Location Address:
NEW YORK STATE DEPARTMENT OF HEALTH AIDS INSTITUTE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10007-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-417-4536
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2011