Provider First Line Business Practice Location Address:
UNIVERSITY AT BUFFALO
Provider Second Line Business Practice Location Address:
STADIUM COMPLEX RM 130
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14260-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-645-6829
Provider Business Practice Location Address Fax Number:
716-645-5574
Provider Enumeration Date:
04/19/2016