Provider First Line Business Practice Location Address:
526 PLUM ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13204-1495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-471-6790
Provider Business Practice Location Address Fax Number:
315-422-2504
Provider Enumeration Date:
12/31/2006