Provider First Line Business Practice Location Address:
725 IRVING AVE
Provider Second Line Business Practice Location Address:
STE 401
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-2878
Provider Business Practice Location Address Fax Number:
315-464-2879
Provider Enumeration Date:
04/24/2006