Provider First Line Business Practice Location Address:
432 E 149TH ST LOWR LEVEL
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:
10455-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-554-7096
Provider Business Practice Location Address Fax Number:
718-502-9478
Provider Enumeration Date:
09/07/2012