Provider First Line Business Practice Location Address:
1001 W FAYETTE ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13204-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-472-1488
Provider Business Practice Location Address Fax Number:
315-472-8060
Provider Enumeration Date:
06/15/2005