Provider First Line Business Practice Location Address:
2589 SEVENTH AVE
Provider Second Line Business Practice Location Address:
P.S. 200 THE JAMES MCCUNE SMITH SCHOOL
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-491-6636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2016