Provider First Line Business Practice Location Address:
48 E KINGSBRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-7514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-933-9603
Provider Business Practice Location Address Fax Number:
718-866-0337
Provider Enumeration Date:
04/14/2008