Provider First Line Business Practice Location Address:
316 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-452-1314
Provider Business Practice Location Address Fax Number:
315-452-1410
Provider Enumeration Date:
11/30/2006