Provider First Line Business Practice Location Address:
3424 KINGSBRIDGE AVE
Provider Second Line Business Practice Location Address:
1H
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-549-2800
Provider Business Practice Location Address Fax Number:
718-549-9008
Provider Enumeration Date:
11/09/2006