Provider First Line Business Practice Location Address:
519 W. 114TH STREET, JOHN JAY BUILDING
Provider Second Line Business Practice Location Address:
HEALTH SERVICES AT COLUMBIA
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-854-2284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007