Provider First Line Business Practice Location Address:
111 EAST 210TH STREET
Provider Second Line Business Practice Location Address:
MONTEFIORE MEDICAL CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-920-2020
Provider Business Practice Location Address Fax Number:
718-881-5439
Provider Enumeration Date:
05/17/2006