Provider First Line Business Practice Location Address:
190 PARRISH ST
Provider Second Line Business Practice Location Address:
APARTMENT 141
Provider Business Practice Location Address City Name:
CANANDAIGUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14424-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-857-5532
Provider Business Practice Location Address Fax Number:
315-781-1302
Provider Enumeration Date:
01/13/2010