Provider First Line Business Practice Location Address:
329 E 148TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
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:
845-423-7822
Provider Business Practice Location Address Fax Number:
917-792-8502
Provider Enumeration Date:
12/26/2012