Provider First Line Business Practice Location Address:
391 E 149TH STREET, SUITE 405
Provider Second Line Business Practice Location Address:
PCMH BRONX ACT PROGRAM
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-215-1117
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2015