Provider First Line Business Practice Location Address:
MS 118 577 EAST 179 ST
Provider Second Line Business Practice Location Address:
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:
10457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-584-2948
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2012