Provider First Line Business Practice Location Address:
1674 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:
14218-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-824-2243
Provider Business Practice Location Address Fax Number:
716-824-7449
Provider Enumeration Date:
09/25/2006