Provider First Line Business Practice Location Address:
927 E 213TH ST
Provider Second Line Business Practice Location Address:
2
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10469-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-427-0506
Provider Business Practice Location Address Fax Number:
718-231-3992
Provider Enumeration Date:
12/19/2006