Provider First Line Business Practice Location Address: 
1500 N JAMES ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ROME
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
13440-2844
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
315-338-7000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/06/2005