Provider First Line Business Practice Location Address:
2901 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:
13208-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-455-8933
Provider Business Practice Location Address Fax Number:
315-455-8934
Provider Enumeration Date:
11/07/2006