Provider First Line Business Practice Location Address:
1629 ELECTRIC AVE
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:
14218-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-315-7667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2021