Provider First Line Business Practice Location Address:
154 EAST 174TH STREET
Provider Second Line Business Practice Location Address:
ASENCIO PHARMACY, INC.
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-299-2416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2010