Provider First Line Business Practice Location Address:
475 IRVING AVE STE 210
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:
13210-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-471-2646
Provider Business Practice Location Address Fax Number:
315-471-1762
Provider Enumeration Date:
11/01/2006