Provider First Line Business Practice Location Address:
998 CROOKED HILL ROAD, BUILDING 56
Provider Second Line Business Practice Location Address:
PILGRIM STATE PSYCHIATRIC CENTER
Provider Business Practice Location Address City Name:
WEST BRENTWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-701-2574
Provider Business Practice Location Address Fax Number:
631-761-2282
Provider Enumeration Date:
02/01/2007