Provider First Line Business Practice Location Address:
253B E 149TH 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:
10451-5503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-402-9104
Provider Business Practice Location Address Fax Number:
718-665-8255
Provider Enumeration Date:
03/15/2007