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| Type | Address | [sources] | |||
|---|---|---|---|---|---|
| Country | United States | [sources] | |||
| City | FAYETTEVILLE | [sources] | |||
| Full address | 1736 EAST GENESEE STREET, FAYETTEVILLE, NY 13066 | [sources] | |||
| Postal code | 13066 | [sources] | |||
| State | NY | [sources] | |||
| Street address | 1736 EAST GENESEE STREET | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers disqualified from participating in New Jersey State's Medicaid program.
United States · OIFP
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