Provider First Line Business Practice Location Address:
600 E. GENESEE STREET
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-299-5454
Provider Business Practice Location Address Fax Number:
315-299-4881
Provider Enumeration Date:
11/15/2005