Provider First Line Business Practice Location Address:
722 W MANLIUS 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:
13057-2158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-432-0665
Provider Business Practice Location Address Fax Number:
315-431-0606
Provider Enumeration Date:
04/28/2010