Provider First Line Business Practice Location Address:
PHOENIX HOUSE
Provider Second Line Business Practice Location Address:
31-51 STONY ST.
Provider Business Practice Location Address City Name:
SHRUB OAK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-962-2491
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006