Provider First Line Business Practice Location Address:
1613 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:
13203-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-435-4457
Provider Business Practice Location Address Fax Number:
315-435-4416
Provider Enumeration Date:
11/14/2011