Provider First Line Business Practice Location Address:
600 E GENESEE ST
Provider Second Line Business Practice Location Address:
SUITE 323
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-476-1645
Provider Business Practice Location Address Fax Number:
315-476-5640
Provider Enumeration Date:
01/23/2006