Provider First Line Business Practice Location Address:
1125 SALT SPRINGS ROAD
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:
13224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-446-6729
Provider Business Practice Location Address Fax Number:
315-446-6760
Provider Enumeration Date:
10/02/2006