Provider First Line Business Practice Location Address:
610 S SALINA ST
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:
13202-3524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-421-7479
Provider Business Practice Location Address Fax Number:
315-473-9853
Provider Enumeration Date:
08/24/2006