Provider First Line Business Practice Location Address:
1226 E WATER 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:
13210-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-478-4185
Provider Business Practice Location Address Fax Number:
315-478-0840
Provider Enumeration Date:
05/14/2012