Provider First Line Business Practice Location Address:
1775 GRAND CONCOURSE, 6TH FLOOR
Provider Second Line Business Practice Location Address:
BRONX- LEBANON HOSPITAL CENTER, DEPT OF DENTISTRY
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-901-8110
Provider Business Practice Location Address Fax Number:
718-901-8162
Provider Enumeration Date:
04/10/2017