Provider First Line Business Practice Location Address:
739 IRVING AVE
Provider Second Line Business Practice Location Address:
SUITE 520
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-477-0077
Provider Business Practice Location Address Fax Number:
315-470-2925
Provider Enumeration Date:
10/19/2005