Provider First Line Business Practice Location Address:
1111 AMSTERDAM AVE
Provider Second Line Business Practice Location Address:
SLH- S&R 8TH FLOOR- EVALUATION UNIT
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-523-4101
Provider Business Practice Location Address Fax Number:
212-523-1077
Provider Enumeration Date:
08/15/2005