Provider First Line Business Practice Location Address:
4900 BROAD ROAD SUITE 1B
Provider Second Line Business Practice Location Address:
COMMUNITY GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13215-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-492-5626
Provider Business Practice Location Address Fax Number:
315-492-5306
Provider Enumeration Date:
02/12/2007