Provider First Line Business Practice Location Address: 
281 PHELPS LANE
    Provider Second Line Business Practice Location Address: 
DIVISION OF DRUG & ALCOHOL SERVICES
    Provider Business Practice Location Address City Name: 
NORTH BABYLON
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11703-4005
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
631-422-7676
    Provider Business Practice Location Address Fax Number: 
631-422-7609
    Provider Enumeration Date: 
11/15/2016