Provider First Line Business Practice Location Address:
320 E 94TH ST FL 2
Provider Second Line Business Practice Location Address:
MOUNT SINAI ADOLESCENT HEALTH CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128-5604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-731-7530
Provider Business Practice Location Address Fax Number:
212-423-2920
Provider Enumeration Date:
09/22/2006