Provider First Line Business Practice Location Address:
339 SCOTT AVE
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:
13224-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-426-8330
Provider Business Practice Location Address Fax Number:
315-426-7887
Provider Enumeration Date:
11/20/2006