Provider First Line Business Practice Location Address:
1120 E 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:
13210-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-475-5540
Provider Business Practice Location Address Fax Number:
315-475-5554
Provider Enumeration Date:
03/20/2013