Provider First Line Business Practice Location Address:
4631 ONONDAGA BLVD
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:
13219-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-487-4844
Provider Business Practice Location Address Fax Number:
315-484-1213
Provider Enumeration Date:
12/22/2005