Provider First Line Business Practice Location Address:
516 PROSPECT 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:
13208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-703-5200
Provider Business Practice Location Address Fax Number:
315-703-5201
Provider Enumeration Date:
03/14/2006