Provider First Line Business Practice Location Address:
1385 ABBOTT RD
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:
14218-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-823-3131
Provider Business Practice Location Address Fax Number:
716-823-0405
Provider Enumeration Date:
11/21/2006