Provider First Line Business Practice Location Address:
1258 ELECTRIC AVENUE
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:
14218-0366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-825-7434
Provider Business Practice Location Address Fax Number:
716-827-1024
Provider Enumeration Date:
08/29/2006