Provider First Line Business Practice Location Address:
4600 BROADWAY
Provider Second Line Business Practice Location Address:
IS 218 DENTAL CLINIC CHILDRENS AID SOCIETY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-567-3500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006