Provider First Line Business Practice Location Address:
530 CEDAR ST
Provider Second Line Business Practice Location Address:
DAY TREATMENT PROGRAM - SOULE ROAD SCHOOL
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-435-7706
Provider Business Practice Location Address Fax Number:
315-435-7715
Provider Enumeration Date:
11/17/2006