Provider First Line Business Practice Location Address:
1350 OAK STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-396-5295
Provider Business Practice Location Address Fax Number:
315-423-0905
Provider Enumeration Date:
03/14/2007