Provider First Line Business Practice Location Address:
565 W 181ST ST
Provider Second Line Business Practice Location Address:
181 PHARMACY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10033-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-543-2616
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2007