Provider First Line Business Practice Location Address:
1446 WHITE PLAINS RD
Provider Second Line Business Practice Location Address:
REAR BASEMENT
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10462-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-625-2812
Provider Business Practice Location Address Fax Number:
845-517-3412
Provider Enumeration Date:
03/23/2015