Provider First Line Business Practice Location Address:
183 WEST 231ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-543-1123
Provider Business Practice Location Address Fax Number:
718-581-2681
Provider Enumeration Date:
12/12/2006