Provider First Line Business Practice Location Address:
187 NORTHERN CONCOURSE
Provider Second Line Business Practice Location Address:
OPWDD
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-473-6944
Provider Business Practice Location Address Fax Number:
315-473-3186
Provider Enumeration Date:
02/21/2018