Provider First Line Business Practice Location Address:
3229 EAST GENESEE ST STE 1
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:
13214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-5726
Provider Business Practice Location Address Fax Number:
315-464-2510
Provider Enumeration Date:
06/13/2011