Organization
BUFFALO ATHLETIC CLUB SOUTHTOWNS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MILLER (PARTNER/GM)
(716) 675-9353
Entity
Organization
Contact information
Practice address
3035 UNION RD, ORCHARD PARK, NY 14127-1214
(716) 675-9353
Mailing address
3035 UNION RD., ORCHARD PARK, NY 14127
(716) 675-9353
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000513288001
BLUE CROSS BLUE SHEILD OF WNY
NY
Enumeration date
09/29/2009
Last updated
09/29/2009
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