Provider First Line Business Practice Location Address:
819 E 169TH ST
Provider Second Line Business Practice Location Address:
PRIVATE HOUSE- 1ST FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10459-1764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-860-6448
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2006