Provider First Line Business Practice Location Address:
15 CANANDAIGUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHORTSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14548-9763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-289-3560
Provider Business Practice Location Address Fax Number:
585-289-3570
Provider Enumeration Date:
08/30/2006