Provider First Line Business Practice Location Address:
100 WEST MOSHULU PARKWAY SOUTH
Provider Second Line Business Practice Location Address:
DEWITT CLINTON HIGH SCHOOL
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-549-8022
Provider Business Practice Location Address Fax Number:
718-549-7977
Provider Enumeration Date:
10/06/2006