Provider First Line Business Practice Location Address:
2434 JEROME AVE
Provider Second Line Business Practice Location Address:
C/O K & G 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:
10468-6401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-220-2014
Provider Business Practice Location Address Fax Number:
844-304-2611
Provider Enumeration Date:
08/22/2005