Provider First Line Business Practice Location Address:
5496 EAST TAFT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-552-6700
Provider Business Practice Location Address Fax Number:
315-552-6701
Provider Enumeration Date:
04/25/2007