Provider First Line Business Practice Location Address:
BOX 777
Provider Second Line Business Practice Location Address:
601 ELMWOOD AVENUE
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-275-9784
Provider Business Practice Location Address Fax Number:
585-756-8054
Provider Enumeration Date:
02/15/2007