Provider First Line Business Practice Location Address:
120 EAST WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-422-0854
Provider Business Practice Location Address Fax Number:
315-471-1577
Provider Enumeration Date:
11/24/2006