Provider First Line Business Practice Location Address:
455 EAST 138TH STREET
Provider Second Line Business Practice Location Address:
GROUND FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-552-2895
Provider Business Practice Location Address Fax Number:
718-552-2900
Provider Enumeration Date:
02/23/2021