Provider First Line Business Practice Location Address:
1000 E GENESEE ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-472-8835
Provider Business Practice Location Address Fax Number:
315-476-3712
Provider Enumeration Date:
01/03/2006