Provider First Line Business Practice Location Address:
401 EAST 147TH STREET
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:
10455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-402-5244
Provider Business Practice Location Address Fax Number:
718-402-5312
Provider Enumeration Date:
05/26/2010