Provider First Line Business Practice Location Address:
977 FOX STREET
Provider Second Line Business Practice Location Address:
MMC AT IS 216 AND 217/RAFAEL HERNANDEZ MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10459-3320
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:
09/05/2007