Provider First Line Business Practice Location Address:
163 WEST 125TH STREET
Provider Second Line Business Practice Location Address:
MPC 125TH STREET CLINIC,
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-866-2751
Provider Business Practice Location Address Fax Number:
212-866-2760
Provider Enumeration Date:
05/10/2007