Provider First Line Business Practice Location Address:
736 IRVING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-470-7111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2005