Provider First Line Business Practice Location Address:
529 E 138TH 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:
10454-4925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-618-7543
Provider Business Practice Location Address Fax Number:
718-618-7545
Provider Enumeration Date:
09/12/2008