Provider First Line Business Practice Location Address:
234 E 149TH ST, BRONX, NY 10451
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-579-6011
Provider Business Practice Location Address Fax Number:
718-579-4822
Provider Enumeration Date:
04/10/2023