Provider First Line Business Practice Location Address:
BROAD RD
Provider Second Line Business Practice Location Address:
COMMUNITY HOSPITAL POB SUITE 2S
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13215-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-492-5794
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2006