Provider First Line Business Practice Location Address:
234 E 149TH ST 10-C
Provider Second Line Business Practice Location Address:
BRONX NEW YORK
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-579-5000
Provider Business Practice Location Address Fax Number:
718-579-5284
Provider Enumeration Date:
01/29/2007