Provider First Line Business Practice Location Address:
833 E GENESEE 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:
13210-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-476-9246
Provider Business Practice Location Address Fax Number:
315-476-6421
Provider Enumeration Date:
09/20/2006