Provider First Line Business Practice Location Address:
430 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212-2844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-458-1231
Provider Business Practice Location Address Fax Number:
315-458-8558
Provider Enumeration Date:
09/27/2006