Provider First Line Business Practice Location Address:
234 EAST 149TH STREET
Provider Second Line Business Practice Location Address:
1C2
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451-5504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-579-5000
Provider Business Practice Location Address Fax Number:
718-579-4987
Provider Enumeration Date:
10/08/2024