Provider First Line Business Practice Location Address:
202 ROOSEVELT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-2937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-461-3243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2007