Provider First Line Business Practice Location Address:
635 W 165TH ST
Provider Second Line Business Practice Location Address:
INTENSIVE OUTPATIENT PROGRAM - EI 4TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-305-9758
Provider Business Practice Location Address Fax Number:
212-305-4724
Provider Enumeration Date:
06/21/2006