Provider First Line Business Practice Location Address:
156 WEST AVE
Provider Second Line Business Practice Location Address:
LAKESIDE MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
BROCKPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-395-6095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2006