Provider First Line Business Practice Location Address:
1201 E FAYETTE ST
Provider Second Line Business Practice Location Address:
SUITE #15
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-422-1213
Provider Business Practice Location Address Fax Number:
315-422-1216
Provider Enumeration Date:
10/23/2009