Provider First Line Business Practice Location Address:
327 BEACH 19TH STREET
Provider Second Line Business Practice Location Address:
ST JOHN'S EPISCOPAL HOSPITAL CMHC
Provider Business Practice Location Address City Name:
ROCKAWAY BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-869-8822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006