Provider First Line Business Practice Location Address:
5496 E TAFT RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NORTH SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212-3784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-451-6541
Provider Business Practice Location Address Fax Number:
315-451-7059
Provider Enumeration Date:
07/15/2005