Provider First Line Business Practice Location Address:
314 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-443-9884
Provider Business Practice Location Address Fax Number:
315-410-5554
Provider Enumeration Date:
07/23/2010