Provider First Line Business Practice Location Address:
753 JAMES STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13203-2163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-479-6900
Provider Business Practice Location Address Fax Number:
315-472-1191
Provider Enumeration Date:
08/02/2006