Provider First Line Business Practice Location Address:
ST. JOHN'S EPISCOPAL HOSPITAL, CMHC
Provider Second Line Business Practice Location Address:
521 BEACH 20TH STREET
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-869-8822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2007