Provider First Line Business Practice Location Address:
326 E 149TH ST
Provider Second Line Business Practice Location Address:
SOUTHERN MEDICAL GROUP
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451-5602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-585-6100
Provider Business Practice Location Address Fax Number:
718-402-5034
Provider Enumeration Date:
12/26/2012