Provider First Line Business Practice Location Address:
917 GRANGER RD
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:
13219-2165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-487-8451
Provider Business Practice Location Address Fax Number:
315-487-8451
Provider Enumeration Date:
12/28/2005