Provider First Line Business Practice Location Address:
413 EAST 120TH STREET 2ND FLOOR
Provider Second Line Business Practice Location Address:
HARLEM MULTI SERVICE CENTER - DOHMH
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-807-2359
Provider Business Practice Location Address Fax Number:
917-492-6977
Provider Enumeration Date:
04/09/2012