Provider First Line Business Practice Location Address:
2810 COURT 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:
13208-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-454-0656
Provider Business Practice Location Address Fax Number:
315-454-8382
Provider Enumeration Date:
10/19/2005