Provider First Line Business Practice Location Address:
324 UNIVERSITY AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-472-4471
Provider Business Practice Location Address Fax Number:
315-472-8869
Provider Enumeration Date:
09/07/2006