Provider First Line Business Practice Location Address:
178-10 WEXFORD TERRACE
Provider Second Line Business Practice Location Address:
ADVANCED CENTER FOR PSYCHOTHERAPY
Provider Business Practice Location Address City Name:
JAMAICA ESTATES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-658-1123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2008