Provider First Line Business Practice Location Address:
725 IRVING AVENUE SUITE 112
Provider Second Line Business Practice Location Address:
CENTER FOR NEURODEVELOPMEMTL PEDIATRICS CROUSE POB
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-2089
Provider Business Practice Location Address Fax Number:
315-464-6398
Provider Enumeration Date:
07/10/2008