Provider First Line Business Practice Location Address:
804 EAST 138TH STREET
Provider Second Line Business Practice Location Address:
ROOM 32 ALBERT EINSEIN WELLNESS CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-665-7500
Provider Business Practice Location Address Fax Number:
718-665-4768
Provider Enumeration Date:
07/22/2010