Provider First Line Business Practice Location Address:
4202 W GENESEE 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:
13219-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-487-0326
Provider Business Practice Location Address Fax Number:
315-487-0508
Provider Enumeration Date:
08/24/2006