Provider First Line Business Practice Location Address:
CHD MERIDIAN HEALTHCARE, JEP
Provider Second Line Business Practice Location Address:
4720 BAKERST, EXT.
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-456-2149
Provider Business Practice Location Address Fax Number:
716-456-2628
Provider Enumeration Date:
05/17/2007