Provider First Line Business Practice Location Address:
389 E 138TH ST
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:
10454-3099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-742-0001
Provider Business Practice Location Address Fax Number:
718-742-0011
Provider Enumeration Date:
02/01/2008