Provider First Line Business Practice Location Address:
1101 ERIE BLVD EAST
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:
13210-3087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-422-4412
Provider Business Practice Location Address Fax Number:
315-422-4690
Provider Enumeration Date:
06/22/2006