Provider First Line Business Practice Location Address:
475 IRVING AVE
Provider Second Line Business Practice Location Address:
STE. 094
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-422-2380
Provider Business Practice Location Address Fax Number:
315-474-7692
Provider Enumeration Date:
10/20/2006