Provider First Line Business Practice Location Address:
1065 JAMES ST
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:
13203-2787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-454-4700
Provider Business Practice Location Address Fax Number:
315-454-4646
Provider Enumeration Date:
06/22/2010