Provider First Line Business Practice Location Address:
BETTY PARKER BUILDING
Provider Second Line Business Practice Location Address:
1500 WATERS PLACE, WARD 20
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-409-9450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006