Provider First Line Business Practice Location Address:
2712 JAMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13206-2243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-463-7504
Provider Business Practice Location Address Fax Number:
315-463-7498
Provider Enumeration Date:
01/16/2007