Provider First Line Business Practice Location Address:
918 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:
13203-2593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-474-1561
Provider Business Practice Location Address Fax Number:
315-422-0433
Provider Enumeration Date:
04/25/2007