Provider First Line Business Practice Location Address:
307 S TOWNSEND 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:
13202-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-424-9108
Provider Business Practice Location Address Fax Number:
315-682-0908
Provider Enumeration Date:
12/22/2008