Provider First Line Business Practice Location Address:
BROAD RD S 2D
Provider Second Line Business Practice Location Address:
COMMUNITY GENERAL HOSPITAL POB
Provider Business Practice Location Address City Name:
SYRAUCSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-492-5755
Provider Business Practice Location Address Fax Number:
315-492-5246
Provider Enumeration Date:
09/30/2008