Provider First Line Business Practice Location Address:
22 E KINGSBRIDGE RD
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:
10468-7596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-801-1199
Provider Business Practice Location Address Fax Number:
917-801-1198
Provider Enumeration Date:
11/15/2013