Provider First Line Business Practice Location Address:
961 CANAL ST
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:
13210-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-454-6000
Provider Business Practice Location Address Fax Number:
315-428-9223
Provider Enumeration Date:
07/27/2021