Provider First Line Business Practice Location Address:
3100 E GENESEE ST
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:
13224-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-435-4139
Provider Business Practice Location Address Fax Number:
315-435-4196
Provider Enumeration Date:
10/27/2011