Provider First Line Business Practice Location Address:
1713 UNIVERSITY AVE
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:
10453-6961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-299-3044
Provider Business Practice Location Address Fax Number:
718-299-4809
Provider Enumeration Date:
11/25/2005