Individual
KEITH BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 GAFFNEY DR, WATERTOWN, NY 13601-1823
(315) 414-6413
Mailing address
313 N CLINTON ST, CARTHAGE, NY 13619-1017
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/17/2022
Last updated
02/17/2022
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