Provider First Line Business Practice Location Address:
1419 SALT SPRINGS RD DEPT OF
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:
13214-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-385-1253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2024