Provider First Line Business Practice Location Address:
1049 FRANKLIN AVENUE
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:
10456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-861-5650
Provider Business Practice Location Address Fax Number:
718-861-5654
Provider Enumeration Date:
08/23/2006