Provider First Line Business Practice Location Address: 
3020 BAILEY AVE
    Provider Second Line Business Practice Location Address: 
2ND FLOOR
    Provider Business Practice Location Address City Name: 
BUFFALO
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14215-2814
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
716-831-1800
    Provider Business Practice Location Address Fax Number: 
716-831-1818
    Provider Enumeration Date: 
07/14/2011