Provider First Line Business Practice Location Address:
739 IRVING AVE
Provider Second Line Business Practice Location Address:
SUITE 520, CHY MEDICAL CENTER
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-470-1051
Provider Business Practice Location Address Fax Number:
315-470-1380
Provider Enumeration Date:
03/17/2006