Provider First Line Business Practice Location Address:
531 E 138TH ST
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:
10454-3087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-993-5959
Provider Business Practice Location Address Fax Number:
718-993-5959
Provider Enumeration Date:
10/24/2005