Provider First Line Business Practice Location Address:
450 CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
COLUMBIA PROFESSIONAL MEDICAL BUILDING
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-683-5012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2008