Provider First Line Business Practice Location Address:
218 HARRISON ST
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:
13202-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-396-0325
Provider Business Practice Location Address Fax Number:
315-396-0497
Provider Enumeration Date:
12/27/2010