Provider First Line Business Practice Location Address:
116 E CASTLE 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:
13205-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-475-1641
Provider Business Practice Location Address Fax Number:
315-478-0688
Provider Enumeration Date:
11/25/2005