Provider First Line Business Practice Location Address:
1628 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:
13204-1952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-472-7128
Provider Business Practice Location Address Fax Number:
315-472-9844
Provider Enumeration Date:
09/23/2006