Provider First Line Business Practice Location Address:
6400 FREMONT RD
Provider Second Line Business Practice Location Address:
EAST SYRACUSE MINOA HS
Provider Business Practice Location Address City Name:
EAST SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057-9436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-434-3300
Provider Business Practice Location Address Fax Number:
315-434-3360
Provider Enumeration Date:
10/10/2016