Provider First Line Business Practice Location Address:
112 DEWITT ST
Provider Second Line Business Practice Location Address:
STE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-254-4804
Provider Business Practice Location Address Fax Number:
315-218-5266
Provider Enumeration Date:
10/24/2006