Provider First Line Business Practice Location Address:
120 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 308
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-422-0453
Provider Business Practice Location Address Fax Number:
315-638-2034
Provider Enumeration Date:
09/06/2006