Provider First Line Business Practice Location Address:
2545 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
ATTN BRONX LTHHCP
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-4066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-367-1125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2006