Provider First Line Business Practice Location Address:
1400 PELHAM PKWY S
Provider Second Line Business Practice Location Address:
JACOBI MEDICAL CENTER 1E12
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-918-5233
Provider Business Practice Location Address Fax Number:
718-918-7785
Provider Enumeration Date:
11/04/2005