Provider First Line Business Practice Location Address:
385 E 149 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:
10455-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-402-2240
Provider Business Practice Location Address Fax Number:
718-402-2250
Provider Enumeration Date:
12/12/2008