Provider First Line Business Practice Location Address:
222 BRIDGE 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:
13057-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-434-9353
Provider Business Practice Location Address Fax Number:
315-434-5581
Provider Enumeration Date:
04/03/2006