Provider First Line Business Practice Location Address: 
50 DAYTON LN
    Provider Second Line Business Practice Location Address: 
ANDRUS CHILDREN'S CENTER MENTAL HEALTH DIVISION
    Provider Business Practice Location Address City Name: 
PEEKSKILL
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10566-2860
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
914-736-3371
    Provider Business Practice Location Address Fax Number: 
914-736-3372
    Provider Enumeration Date: 
05/12/2006