Provider First Line Business Practice Location Address:
720 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-425-0373
Provider Business Practice Location Address Fax Number:
315-425-0373
Provider Enumeration Date:
01/30/2007