Provider First Line Business Practice Location Address:
1301 E COLVIN ST
Provider Second Line Business Practice Location Address:
MANLEY FIELD HOUSE
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13244-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-341-4785
Provider Business Practice Location Address Fax Number:
315-443-2548
Provider Enumeration Date:
11/22/2016