Provider First Line Business Practice Location Address:
1025 MORRISON AVENUE
Provider Second Line Business Practice Location Address:
JHS 123
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-328-2105
Provider Business Practice Location Address Fax Number:
718-328-8561
Provider Enumeration Date:
04/03/2012