Provider First Line Business Practice Location Address:
335 MONTGOMERY ST
Provider Second Line Business Practice Location Address:
CARNEGIE SCHOOL ROOM 200
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-435-4210
Provider Business Practice Location Address Fax Number:
315-435-4553
Provider Enumeration Date:
04/08/2011