Provider First Line Business Practice Location Address:
196 COMSTOCK AVE APT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-465-7596
Provider Business Practice Location Address Fax Number:
716-465-7596
Provider Enumeration Date:
01/07/2008