Provider First Line Business Practice Location Address:
922 SPENCER 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:
13204-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-492-1964
Provider Business Practice Location Address Fax Number:
315-469-9741
Provider Enumeration Date:
02/01/2010