Provider First Line Business Practice Location Address:
125 LAWRENCE ROAD EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212-3844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-455-5500
Provider Business Practice Location Address Fax Number:
315-455-8619
Provider Enumeration Date:
04/21/2006