Provider First Line Business Practice Location Address:
MMC DENTAL AT PROSPECT AVENUE
Provider Second Line Business Practice Location Address:
951 PROSPECT AVENUE
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10459-2967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-377-4722
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2007