Provider First Line Business Practice Location Address:
2200 E GENESEE ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-2298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-472-4584
Provider Business Practice Location Address Fax Number:
315-472-4620
Provider Enumeration Date:
09/21/2005