Provider First Line Business Practice Location Address:
1265 FULTON AVENUE
Provider Second Line Business Practice Location Address:
BRONX LEBENON SPECIAL CARE CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10456-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-579-7060
Provider Business Practice Location Address Fax Number:
718-579-7417
Provider Enumeration Date:
05/12/2006