Provider First Line Business Practice Location Address:
12 CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 4 - PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
FREDONIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14063-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-672-8790
Provider Business Practice Location Address Fax Number:
716-672-8794
Provider Enumeration Date:
09/21/2010