Provider First Line Business Practice Location Address:
4900 BROAD RD.
Provider Second Line Business Practice Location Address:
UPSTATE COMMUNITY MEDICAL
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13215-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-8200
Provider Business Practice Location Address Fax Number:
315-464-8206
Provider Enumeration Date:
11/15/2012