Provider First Line Business Practice Location Address:
6085 COURT STREET RD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13206-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-434-8804
Provider Business Practice Location Address Fax Number:
315-434-8899
Provider Enumeration Date:
12/20/2006