Provider First Line Business Practice Location Address:
537 539 EAST 138TH STREET
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:
10454-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-402-5550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006