Individual
MRS. GLORIA R TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
697 RIDGE RD, LACKAWANNA, NY 14218-1500
(716) 822-4781
Mailing address
5783 DOVER RD, LAKE VIEW, NY 14085-9700
(716) 627-2289
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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