Provider First Line Business Practice Location Address:
302 HIGHLAND ST
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13203-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-420-1748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2011