Provider First Line Business Practice Location Address:
1545 UNIONPORT RD
Provider Second Line Business Practice Location Address:
PARK SOUTH MEDICAL
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-892-2201
Provider Business Practice Location Address Fax Number:
718-828-9663
Provider Enumeration Date:
08/02/2006