Provider First Line Business Practice Location Address: 
55 DODGE RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
GETZVILLE
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14068-1205
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
716-650-5100
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/16/2006