Provider First Line Business Practice Location Address:
400 SUNRISE HIGHWAY
Provider Second Line Business Practice Location Address:
ADOLESCENT PARTIAL PROGRAM OF SOUTH OAKS HOSPITAL WILSE
Provider Business Practice Location Address City Name:
AMITYVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-608-5341
Provider Business Practice Location Address Fax Number:
631-393-8743
Provider Enumeration Date:
10/05/2007