Provider First Line Business Practice Location Address:
120 JOSEPHINE ST
Provider Second Line Business Practice Location Address:
SYRACUSE
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13208-2744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-708-3654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2007