Provider First Line Business Practice Location Address:
1616 ABBOTT RD
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:
14218-2937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-823-1770
Provider Business Practice Location Address Fax Number:
716-332-4329
Provider Enumeration Date:
12/17/2007