Provider First Line Business Practice Location Address:
58 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:
10468-7517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-295-8243
Provider Business Practice Location Address Fax Number:
718-584-3805
Provider Enumeration Date:
08/15/2006