Provider First Line Business Practice Location Address:
642 EAST 227 STREET
Provider Second Line Business Practice Location Address:
PH2
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-710-6219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2007