Provider First Line Business Practice Location Address:
659 WEST ONONDAGA 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:
13204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-475-5176
Provider Business Practice Location Address Fax Number:
315-476-0263
Provider Enumeration Date:
03/20/2007