Provider First Line Business Practice Location Address:
530 OAK ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13203-1652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-882-1958
Provider Business Practice Location Address Fax Number:
315-295-2526
Provider Enumeration Date:
11/21/2006