Provider First Line Business Practice Location Address:
1198 RIDGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACKAWANNA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14218-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-823-1900
Provider Business Practice Location Address Fax Number:
716-823-2730
Provider Enumeration Date:
10/17/2006