Provider First Line Business Practice Location Address:
225 A EAST 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-993-0074
Provider Business Practice Location Address Fax Number:
718-993-0075
Provider Enumeration Date:
12/17/2007