Provider First Line Business Practice Location Address:
234 EAST 149TH STREET
Provider Second Line Business Practice Location Address:
SUITE 4-20
Provider Business Practice Location Address City Name:
THE BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-579-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2022