Provider First Line Business Practice Location Address:
3309 JAMES 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:
13206-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-463-0295
Provider Business Practice Location Address Fax Number:
315-463-0341
Provider Enumeration Date:
11/15/2010