Provider First Line Business Practice Location Address:
1000 E GENESEE ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-471-1044
Provider Business Practice Location Address Fax Number:
315-474-4312
Provider Enumeration Date:
09/30/2005