Provider First Line Business Practice Location Address:
460 WEST 41ST STREET
Provider Second Line Business Practice Location Address:
COVENANT HOUSE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10036
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:
02/13/2007