Provider First Line Business Practice Location Address:
739 IRVING AVENUE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-234-4815
Provider Business Practice Location Address Fax Number:
315-234-4805
Provider Enumeration Date:
01/22/2009