Provider First Line Business Practice Location Address:
322 E 149TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-292-8892
Provider Business Practice Location Address Fax Number:
718-292-8311
Provider Enumeration Date:
07/30/2006