Provider First Line Business Practice Location Address:
507 EAST FAYETTE 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:
13202-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-474-2464
Provider Business Practice Location Address Fax Number:
315-474-2465
Provider Enumeration Date:
12/06/2006