Provider First Line Business Practice Location Address:
1624 UNIVERSITY AVE.
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:
10453-6948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-294-4008
Provider Business Practice Location Address Fax Number:
718-294-9466
Provider Enumeration Date:
01/29/2008