Provider First Line Business Practice Location Address:
1171 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
MANAGEMENT OFFICE
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10456-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-271-8257
Provider Business Practice Location Address Fax Number:
347-271-8258
Provider Enumeration Date:
05/06/2013