Provider First Line Business Practice Location Address:
600 E GENESEE ST
Provider Second Line Business Practice Location Address:
STE 113
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-476-7406
Provider Business Practice Location Address Fax Number:
315-476-7408
Provider Enumeration Date:
07/03/2007