Provider First Line Business Practice Location Address:
712 E FAYETTE 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:
13210-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-422-6211
Provider Business Practice Location Address Fax Number:
315-479-5660
Provider Enumeration Date:
07/12/2005