Provider First Line Business Practice Location Address:
2105 W GENESEE ST
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:
13219-1698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-468-3239
Provider Business Practice Location Address Fax Number:
315-468-2917
Provider Enumeration Date:
05/22/2012