Provider First Line Business Practice Location Address:
104 UNION AVENUE AND TOWNSEND STREET
Provider Second Line Business Practice Location Address:
SUITE 803
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-701-5757
Provider Business Practice Location Address Fax Number:
315-476-8519
Provider Enumeration Date:
10/18/2005