Provider First Line Business Practice Location Address:
413 E 120TH ST
Provider Second Line Business Practice Location Address:
LA CLINICA DEL BARRIO, 1ST FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
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:
212-410-7940
Provider Business Practice Location Address Fax Number:
212-410-9236
Provider Enumeration Date:
01/10/2007