Provider First Line Business Practice Location Address:
NASH STREET BUILDING # T-28
Provider Second Line Business Practice Location Address:
DEPARTMENT OF BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
FORT DRUM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-772-0961
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2005