Provider First Line Business Practice Location Address:
79 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14214-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-838-1914
Provider Business Practice Location Address Fax Number:
716-282-2184
Provider Enumeration Date:
08/31/2010