Provider First Line Business Practice Location Address:
CLOVE LAKES CENTER FOR PSYCH
Provider Second Line Business Practice Location Address:
1346 VICTORY BOULEVARD
Provider Business Practice Location Address City Name:
STATE ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-273-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006