Provider First Line Business Practice Location Address:
1234 ABBOTT RD STE 13
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:
14218-1944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-826-9230
Provider Business Practice Location Address Fax Number:
716-826-9539
Provider Enumeration Date:
08/28/2006