Provider First Line Business Practice Location Address:
3277 SOUTH PARK 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-825-6766
Provider Business Practice Location Address Fax Number:
716-825-6766
Provider Enumeration Date:
09/21/2006