Provider First Line Business Practice Location Address:
1276 FULTON AVENUE
Provider Second Line Business Practice Location Address:
DPT OF PSYCHIATRY, 5TH FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-901-8653
Provider Business Practice Location Address Fax Number:
718-901-8656
Provider Enumeration Date:
03/20/2020