Provider First Line Business Practice Location Address:
519 W. 114TH STREET
Provider Second Line Business Practice Location Address:
HEALTH SERVICES AT COLUMBIA JOHN JAY BUILDING
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:
212-854-9838
Provider Business Practice Location Address Fax Number:
212-854-1155
Provider Enumeration Date:
02/09/2007