Provider First Line Business Practice Location Address:
416 E RAYNOR AVE
Provider Second Line Business Practice Location Address:
DR. MARTIN LUTHER KING SCHOOL
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-3951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-435-6000
Provider Business Practice Location Address Fax Number:
315-435-6207
Provider Enumeration Date:
01/24/2009