Provider First Line Business Practice Location Address:
2315 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
P. S. 159 MEDICAL ROOM
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10458-7754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-933-7381
Provider Business Practice Location Address Fax Number:
718-933-7381
Provider Enumeration Date:
03/09/2012