Provider First Line Business Practice Location Address:
112 E YATES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-863-0428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2008