Provider First Line Business Practice Location Address:
1301 5TH AVE
Provider Second Line Business Practice Location Address:
EXECUTIVE OFFICE NORTHSIDE CENTER FOR CHILD DEVELOP
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-426-3410
Provider Business Practice Location Address Fax Number:
212-426-8919
Provider Enumeration Date:
04/17/2007