Provider First Line Business Practice Location Address: 
1400 PELHAM PKWY S
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF EMERGENCY MEDICINE
    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: 
718-918-5820
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/10/2009