Provider First Line Business Practice Location Address:
1332 NOBLE AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10472-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-591-2550
Provider Business Practice Location Address Fax Number:
347-297-2551
Provider Enumeration Date:
09/01/2010