Provider First Line Business Practice Location Address:
215 E WATER 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:
13202-1159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-472-6935
Provider Business Practice Location Address Fax Number:
315-472-6936
Provider Enumeration Date:
10/09/2007