Provider First Line Business Practice Location Address:
792 NORTH MAIN STREET
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:
13212-1660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-452-4670
Provider Business Practice Location Address Fax Number:
315-579-4670
Provider Enumeration Date:
12/26/2007