Provider First Line Business Practice Location Address:
125 SHOP CITY PLAZA
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:
13206-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-463-7700
Provider Business Practice Location Address Fax Number:
315-463-2938
Provider Enumeration Date:
04/11/2006