Provider First Line Business Practice Location Address:
406 UNIVERSITY AVE
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:
13210-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-472-4701
Provider Business Practice Location Address Fax Number:
315-471-0411
Provider Enumeration Date:
05/23/2005