Provider First Line Business Practice Location Address:
245 S SHORE BLVD
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:
14218-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-827-6731
Provider Business Practice Location Address Fax Number:
716-827-6700
Provider Enumeration Date:
11/01/2011