Provider First Line Business Practice Location Address:
413 EAST 120TH STREET, 2ND / 3RD FLOOR
Provider Second Line Business Practice Location Address:
HARLEM MULTI-SERVICE CENTER - DOHMH OSH
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10035-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-492-6950
Provider Business Practice Location Address Fax Number:
917-492-6972
Provider Enumeration Date:
05/03/2012