Provider First Line Business Practice Location Address:
VAMC/LAB113/C369
Provider Second Line Business Practice Location Address:
800 IRVING AVENUE
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-425-4802
Provider Business Practice Location Address Fax Number:
315-425-4805
Provider Enumeration Date:
04/07/2006