Provider First Line Business Practice Location Address:
220 E. 76TH ST.
Provider Second Line Business Practice Location Address:
M167 ROBERT F. WAGNER MIDDLE 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:
10021-2989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-535-8610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2012