Provider First Line Business Practice Location Address:
1208 FRANKLIN AVE APT 2B
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:
10456-4384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-226-0841
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2018