Provider First Line Business Practice Location Address:
3175 E GENESEE ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13224-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-446-6282
Provider Business Practice Location Address Fax Number:
315-446-3491
Provider Enumeration Date:
05/31/2007