Provider First Line Business Practice Location Address:
122 AMSTERDAM AVE
Provider Second Line Business Practice Location Address:
SCHOOL BASED CLINIC AT MARTIN LUTHER KING HS
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10023-6407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-501-1276
Provider Business Practice Location Address Fax Number:
212-721-3369
Provider Enumeration Date:
01/23/2007