Provider First Line Business Practice Location Address:
603 OSWEGO 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:
13204-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-424-0800
Provider Business Practice Location Address Fax Number:
315-424-1928
Provider Enumeration Date:
11/05/2012