Provider First Line Business Practice Location Address:
725 IRVING AVE
Provider Second Line Business Practice Location Address:
PHYSICIAN'S OFFICE BUILDING, SUITE 112
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-6395
Provider Business Practice Location Address Fax Number:
315-464-6398
Provider Enumeration Date:
09/21/2006