Provider First Line Business Practice Location Address:
2827 JAMES ST
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13206-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-727-4742
Provider Business Practice Location Address Fax Number:
315-469-4474
Provider Enumeration Date:
12/29/2009