Provider First Line Business Practice Location Address:
1912 MIDLAND 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:
13205-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-475-8089
Provider Business Practice Location Address Fax Number:
315-475-8089
Provider Enumeration Date:
11/30/2009