Provider First Line Business Practice Location Address:
329 E. 149TH STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451-5601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-450-8054
Provider Business Practice Location Address Fax Number:
718-450-8092
Provider Enumeration Date:
01/09/2020