Provider First Line Business Practice Location Address:
3230 BAINBRIDGE AVE
Provider Second Line Business Practice Location Address:
STD CENTER SUITE D
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-3963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-882-5482
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2009