Provider First Line Business Practice Location Address:
3930 E GENESEE 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:
13214-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-471-6188
Provider Business Practice Location Address Fax Number:
315-471-0271
Provider Enumeration Date:
08/11/2006