Provider First Line Business Practice Location Address:
816 BARTHOLDI ST
Provider Second Line Business Practice Location Address:
PH
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-961-5165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2012