Provider First Line Business Practice Location Address:
600 E GENESEE ST
Provider Second Line Business Practice Location Address:
106
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-3536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-425-0348
Provider Business Practice Location Address Fax Number:
315-426-9315
Provider Enumeration Date:
04/12/2006