Provider First Line Business Practice Location Address: 
500 N MAIN ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CANANDAIGUA
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14424-1022
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
585-394-3322
    Provider Business Practice Location Address Fax Number: 
585-394-1175
    Provider Enumeration Date: 
04/15/2014