Provider First Line Business Practice Location Address:
951 NIAGARA STREET
Provider Second Line Business Practice Location Address:
ADOLESCENT PROGRAM
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-818-7195
Provider Business Practice Location Address Fax Number:
716-884-1758
Provider Enumeration Date:
08/20/2008