Provider First Line Business Practice Location Address:
630 W 168TH ST
Provider Second Line Business Practice Location Address:
CH 517 CHILDRENS HOSP OF NY DEPT PEDIATRICS
Provider Business Practice Location Address City Name:
NYC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-342-3060
Provider Business Practice Location Address Fax Number:
212-342-6010
Provider Enumeration Date:
01/05/2006