Provider First Line Business Practice Location Address:
777 SEAVIEW AVENUE
Provider Second Line Business Practice Location Address:
BUILDING A SOUTH BEACH PSYCHIATRIC CENTER
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305-3499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-667-5202
Provider Business Practice Location Address Fax Number:
718-351-1958
Provider Enumeration Date:
10/19/2006