Provider First Line Business Practice Location Address:
239 EAST 198TH STREET
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:
10458-3147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-933-1465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006