Provider First Line Business Practice Location Address:
5217 SOUTH SALINA 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:
13205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-469-1712
Provider Business Practice Location Address Fax Number:
315-492-1351
Provider Enumeration Date:
11/08/2006