Provider First Line Business Practice Location Address:
1650 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
BRONX LEBANON HOSPITAL CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
10457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-518-5204
Provider Business Practice Location Address Fax Number:
718-716-8252
Provider Enumeration Date:
02/14/2007