Provider First Line Business Practice Location Address:
1707 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:
14218-2940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-822-3831
Provider Business Practice Location Address Fax Number:
716-822-3832
Provider Enumeration Date:
11/08/2006