Provider First Line Business Practice Location Address:
324 UNIVERSITY AVE
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:
13210-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-472-4471
Provider Business Practice Location Address Fax Number:
315-473-1759
Provider Enumeration Date:
08/29/2006