Provider First Line Business Practice Location Address:
6789 E GENESEE ST
Provider Second Line Business Practice Location Address:
ATTN: PHARMACY MANAGER
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13066-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-446-4660
Provider Business Practice Location Address Fax Number:
315-446-7750
Provider Enumeration Date:
12/01/2005