Provider First Line Business Practice Location Address:
33 WILKESBARRE AVENUE
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:
716-822-6877
Provider Business Practice Location Address Fax Number:
716-827-1726
Provider Enumeration Date:
09/05/2012