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Preferred Location (please select one) Preferred Location (please select one)Buffalo Niagara Medical CampusNorthtowns OfficeSouthtowns Office

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How did you hear about us? How did you hear about us?Family/FriendMedical ProviderOnline SearchAdvertisementRadioPhone BookOther

Are you a new or returning patient? Are you a new or returning patient? New Patient Returning Patient