Provider First Line Business Practice Location Address:
224 S GEDDES 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:
13204-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-471-0550
Provider Business Practice Location Address Fax Number:
315-471-0770
Provider Enumeration Date:
10/04/2005