Provider First Line Business Practice Location Address:
550 HARRISON ST
Provider Second Line Business Practice Location Address:
SUITE L
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:
315-464-5230
Provider Business Practice Location Address Fax Number:
315-464-6663
Provider Enumeration Date:
06/25/2008