Provider First Line Business Practice Location Address:
714 W ONONDAGA ST
Provider Second Line Business Practice Location Address:
APT 8
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13204-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-424-1492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2010