Individual
CARLY J COLVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1247 BRADFORD AVE, APT. 2B, BRONX, NY 10461-6184
(315) 406-2671
Mailing address
1247 BRADFORD AVE, APT. 2B, BRONX, NY 10461-6184
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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