Provider First Line Business Practice Location Address:
2328 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
APT. #1S
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-6249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-221-1544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2007