Provider First Line Business Practice Location Address:
2514 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:
13224-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-445-9022
Provider Business Practice Location Address Fax Number:
315-449-1636
Provider Enumeration Date:
09/30/2005