Provider First Line Business Practice Location Address:
111 WAVERLY AVE.
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:
13244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-443-9005
Provider Business Practice Location Address Fax Number:
315-443-9010
Provider Enumeration Date:
01/22/2007