Provider First Line Business Practice Location Address:
1200 E GENESEE ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-634-2500
Provider Business Practice Location Address Fax Number:
315-634-2503
Provider Enumeration Date:
01/18/2007