Provider First Line Business Practice Location Address:
2105 W GENESEE ST
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13219-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-395-2893
Provider Business Practice Location Address Fax Number:
888-437-6520
Provider Enumeration Date:
07/26/2006