Provider First Line Business Practice Location Address:
MMC - I.R.M.H
Provider Second Line Business Practice Location Address:
141 SOUTH CENTRAL AVENUE
Provider Business Practice Location Address City Name:
HARTSDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-997-1060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006