Provider First Line Business Practice Location Address:
329 E 149TH ST
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:
10451-5625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-769-2698
Provider Business Practice Location Address Fax Number:
718-943-7035
Provider Enumeration Date:
08/06/2019