Provider First Line Business Practice Location Address:
3887 PRATT AVENUE
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:
10466-5930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-324-1481
Provider Business Practice Location Address Fax Number:
718-324-2528
Provider Enumeration Date:
02/15/2007