Provider First Line Business Practice Location Address:
170 INTREPID LANE
Provider Second Line Business Practice Location Address:
HIGH PEAKS
Provider Business Practice Location Address City Name:
SYRACUSES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-492-8319
Provider Business Practice Location Address Fax Number:
315-492-3758
Provider Enumeration Date:
01/23/2009