Provider First Line Business Practice Location Address:
6600 STATE ROUTE 96
Provider Second Line Business Practice Location Address:
FIVE POINTS CORRECTIONAL FACILITY
Provider Business Practice Location Address City Name:
ROMULUS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14541-9560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-869-5111
Provider Business Practice Location Address Fax Number:
607-869-5031
Provider Enumeration Date:
10/05/2006