Provider First Line Business Practice Location Address:
112 E 183RD ST
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:
10453-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-733-9330
Provider Business Practice Location Address Fax Number:
718-329-2717
Provider Enumeration Date:
07/06/2006