Provider First Line Business Practice Location Address:
111 E 210TH ST
Provider Second Line Business Practice Location Address:
MONTEFIORE MEDICAL CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-920-4316
Provider Business Practice Location Address Fax Number:
718-881-2245
Provider Enumeration Date:
01/30/2009