Provider First Line Business Practice Location Address:
460 W 41ST ST
Provider Second Line Business Practice Location Address:
COVENANT HOUSE UNDER 21
Provider Business Practice Location Address City Name:
NYC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10036-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-613-0315
Provider Business Practice Location Address Fax Number:
212-268-2832
Provider Enumeration Date:
12/08/2008