Provider First Line Business Practice Location Address:
1000 E GENESEE ST STE 100A
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:
13210-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-423-4155
Provider Business Practice Location Address Fax Number:
315-423-4199
Provider Enumeration Date:
11/17/2005