Provider First Line Business Practice Location Address:
111 E 210TH ST
Provider Second Line Business Practice Location Address:
MONTEFIORE MEDICAL CENTER- PEDIATRIC DENTISTRY
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-577-4950
Provider Business Practice Location Address Fax Number:
347-577-4926
Provider Enumeration Date:
10/27/2005