Provider First Line Business Practice Location Address:
1716 SOUTHERN BLVD.
Provider Second Line Business Practice Location Address:
EAST BRONX ACADEMY
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-861-8641
Provider Business Practice Location Address Fax Number:
718-861-8634
Provider Enumeration Date:
04/03/2012