Provider First Line Business Practice Location Address:
550 HARRISON ST
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-3188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-6100
Provider Business Practice Location Address Fax Number:
315-464-9245
Provider Enumeration Date:
07/13/2006