Provider First Line Business Practice Location Address:
1425 WALTON AVE
Provider Second Line Business Practice Location Address:
P.S. 64 SCHOOL BASED CLINICBRONXLEBANON HOSPITAL
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10452-6901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-293-0151
Provider Business Practice Location Address Fax Number:
718-588-8743
Provider Enumeration Date:
10/19/2006