Provider First Line Business Practice Location Address:
2165 BRIGHTON HENRIETTA TOWN LINE RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-2755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-385-3920
Provider Business Practice Location Address Fax Number:
585-385-6966
Provider Enumeration Date:
10/27/2005