Provider First Line Business Practice Location Address:
1007 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:
13208-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-422-2623
Provider Business Practice Location Address Fax Number:
315-634-7023
Provider Enumeration Date:
04/20/2007