Provider First Line Business Practice Location Address:
MANLEY FIELD HOUSE
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:
13244-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-443-4775
Provider Business Practice Location Address Fax Number:
315-443-5057
Provider Enumeration Date:
07/09/2006