Provider First Line Business Practice Location Address:
749 W GENESEE 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:
13204-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-428-9945
Provider Business Practice Location Address Fax Number:
315-428-0737
Provider Enumeration Date:
06/28/2005