Provider First Line Business Practice Location Address:
792 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 200B
Provider Business Practice Location Address City Name:
NORTH SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-634-1190
Provider Business Practice Location Address Fax Number:
315-634-1194
Provider Enumeration Date:
05/25/2006