Individual
CRYSTAL ALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED
Contact information
Practice address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 822-4781
Mailing address
801 S HUTH RD, CHEEKTOWAGA, NY 14225-1722
(315) 657-5706
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/12/2015
Last updated
01/12/2015
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