Provider First Line Business Practice Location Address:
961 CANAL STREET
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:
13210-1287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-478-1977
Provider Business Practice Location Address Fax Number:
315-475-2909
Provider Enumeration Date:
03/27/2007