Provider First Line Business Practice Location Address:
1 GUSTAVE L LEVY PL
Provider Second Line Business Practice Location Address:
DEPT. OF PSYCHIATRY, BOX 1230
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-236-0901
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2017