Provider First Line Business Practice Location Address:
1234 ABBOTT RD
Provider Second Line Business Practice Location Address:
SUITE #210
Provider Business Practice Location Address City Name:
LACKAWANNA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14218-1944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-768-2500
Provider Business Practice Location Address Fax Number:
716-768-3355
Provider Enumeration Date:
10/29/2009