Provider First Line Business Practice Location Address:
66 VAN CORTLANDT PARK SOUTH
Provider Second Line Business Practice Location Address:
ST. PATRICKS HOME
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-216-6807
Provider Business Practice Location Address Fax Number:
212-216-6606
Provider Enumeration Date:
01/17/2007